新型脊柱外固定器联合微创技术治疗胸腰椎骨折

Thoracolumbar spinal fractures treated with a new type of spinal external fixation plus microendoscopy

目的探讨新型脊柱外固定器系统联合微创技术治疗胸腰椎骨折的疗效。方法自2005年10月至2008年10月对21例胸腰椎骨折采用新型脊柱外固定器系统复位、固定，通过显微内窥镜椎间盘切除系统（MED）将伤椎塌陷终板骨块推顶复位，再行经皮椎体成形术。结果所有患者随访8～40个月，平均18．5个月。平均每个椎体灌注磷酸钙骨水泥5．5mL；2例术中发生椎管内渗漏，术后患者无神经症状加重；根据影像学评估，末次随访时测得Cobb角、椎体前缘高度比值明显改善，与术前比较差异有统计学意义（P〈0．05），而与术后即刻比较差异无统计学意义（P〉0．05）。VAS疼痛评分、Frankel分级较术前明显好转。结论新型脊柱外固定器系统联合微创技术治疗胸腰椎骨折操作简单、安全性高，可有效恢复椎体力学性能，降低椎体高度再丢失等并发症。

Objective To determine the efficacy of a new type of spinal external fixation plus microendoscopy for the treatment of thoracolumbar spinal fractures. Methods From October 2005 to October 2008, 21 patients with thoracolumbar spinal fractures were treated with a new type of spinal external fixation and microendoscopy. After the collapsed endplate of the injured vertebra was reduced through microendoscopy, the percutaneous vertebroplasty was conducted, followed by external fixation. Results Averagely 5.5 mL of calcium phosphate cement was injected into each column. Cement leaked into the vertebral canal in 2 patients who had no postoperative neural symptoms. According to radiological evaluation, there were statistical significances in Cobb＇s angle and anterior column height between follow-up （8 to 40 months） and preoperation, but no statistical significance was observed between perioperative values. The postoperative VSA scores and the Frankel grading were improved. Conclusion The new type of spinal external fixation plus microendoscopy is simple and safe, and can effectively restore the mechanic properties of the vertebral column and reduce the nostonerative loss of column height.