脊柱外固定器联合椎体成形术在胸腰椎压缩性骨折中的应用

The application of external spinal fixation combined with percutaneous vertebroplasty in the treatment of thoracolumbar vertebrae fractures

目的探讨脊柱外固定器联合椎体成形术(Percutaneous vertabroplasty,PVP)治疗胸腰椎新鲜压缩性骨折的临床疗效。方法2006年10月至2007年10月共收治胸腰椎新鲜压缩性骨折患者17例,均应用脊柱外固定器经皮对骨折椎体进行体外复位固定,同时对骨折椎体进行椎体成形术。随访观察患者骨折椎体椎体前沿高度及后凸角的变化情况。结果所有患者均顺利完成手术,平均手术时间为120min;平均失血量为90ml;每个椎体注入聚甲基丙烯酸甲酯(polymethylmethacrylate,PMMA)2～5ml,平均3.12±0.93ml。术后随访6～20个月,平均14个月。术后X光片示骨折椎体前缘高度为上下椎椎体前缘平均高度的75.89%～105.33%,平均93.17%±8.0%,椎体前缘高度明显恢复(P<0.01);后凸角0°～15°,平均7.53°±4.02°,与术前后比较凸角明显改善(P<0.01)。术后CT发现椎体前缘少量渗漏1例和椎间隙骨水泥漏2例,均无临床症状;钉道感染1例,加强抗感染治疗1周治愈;无螺钉松动外固定断裂、脊髓神经损伤等其他并发症发生。结论应用脊柱外固定器联合椎体成形术治疗胸腰椎新鲜压缩性骨折具有操作简便、创伤小、出血少、安全有效等优点。

Objective To evaluate the clinical efficacy of the thoracolunbar fractures treated with external spinal fixation combined with percutaneous vertebroplasty. Methods From Oct 2006 to Oct 2007, 17 cases of thoraeolumbar vertebrae fractures had been treated by external spinal fixation combined with pereutaneous vertebroplasty.The changes of anterior height of the vertebral body and kyphotic angle between preoperative and postoperative were measured. Results All the surgeries were successful. The average operative time was 120 minutes.The average bleeding volume was 90ml. An average volume of 3.12±0.93ml （range, 2-5ml） cement was injected into each injuried vertebrae body. Followed up for 6 to 20 months （average 14 months） after operation.The average height of anterior boder of injury eentrum after operation was 93.17%± 8.0%（range, 75.89%±105.33%） and increased obviously than before operation （P〈0.01）. The average kyphotic angle after operation was 7.53°±4.02° （range, 0°-15°） and improve obviously than before operation（P〈0.01）. 1 case of cement leakaged to the anterior vertebral edge and 2 cases of cement leakaged into intervertebral space were found on CT after operation without adverse events. 1 case suffered from bolt-hole infection, and had been cured after 1 week through anti-infective therapy. No screw losing and neurological injury ocerued. Conclusion The application of external spinal fixation combined with percutaneous vertebroplasty is effective and safe for thoracolumbar vertebrae fractures which has the advantages of simple manipulation, minimal trauma and less bleeding.