经椎弓根短节段内固定结合磷酸钙骨水泥治疗胸腰椎骨折

Short-segment Pedicle Screw Fixation Combined with Injectable Calcium Phosphate Cement Vertebroplasty in the Treatment of Thoracolumbar Fractures

目的探讨经椎弓根短节段内固定结合注射型磷酸钙骨水泥椎体成形术治疗胸腰椎骨折的方法和疗效。方法2004年5月～2009年7月,对42例胸腰椎骨折采用后路短节段椎弓根钉复位、固定后,再通过伤椎椎弓根灌注注射型磷酸钙骨水泥行椎体成形术。结果本组42例,术后切口均甲级愈合,脊髓神经症状无恶化。每个椎体内注入磷酸钙骨水泥3.0～7.6mL,平均5.2mL。1例术中发生椎管内渗漏,因渗漏量较少,且灌注前已行椎管减压,故未进一步处理。随访12～30个月,平均21个月,除4例神经功能A级症状无改善外,其余均有1～3级的恢复。术后Cobb角0°～12°,椎体前缘高度恢复至90%～100%,平均96.2%。术后12个月时Cobb角0°～16°。根据Alanay等评估方法本组无椎弓根钉失败病例。结论采取经椎弓根短节段内固定结合注射型磷酸钙骨水泥椎体成形术治疗胸腰椎骨折,可有效恢复椎体力学强度,减少高度再丢失及内固定物松动、断裂等并发症的发生,手术操作简单,安全性高。

Objective To evaluate the method and effect of the short-segment pedicle screw fixation combined with injectable calcium phosphate cement vertebroplasty in the treatment of thoracolumbar fractures. Methods From May 2004 to July 2009,in 42 cases of thoracolumbar fractures using short-segment posterior pedicle screw reset,internal fixation,and inject the injectable calcium phosphate cement through pedicle in the injury Vertebral to perform vertebroplasty. Results 42 incisions were healed up in first degree, No symptoms of spinal cord injury aggravated. 3 - 7.6mL calcium phosphate bone cement was injected into each vertebra,the average is 5.2mL. Only 1 case of intraoperative spinal canal leakage occurred,due to less leakage,and vertebral tube decompression has been performed before injection,Therefore, no further treatment followed.Follow-up of 12- 30 months,an average of 21 months,ln addition to 4 cases of neurological function A neurological symptoms without improvement, the rest are 1 -3 grade recovery. Postoperative Cobb angle ranged between 0°- 12° ,Anterior edge height of compressed vertebral bodies recovered to 90% - 100%,with an average 96.2% 12 months later Cobb angle ranged between 0°-16°. According to Alanay and other assessment methods：there was no case of pedicle screw failure. Conclusion The treatment of thoracolumbar fracture used short-segment pedicle screw internal fixation combined with injectable calcium phosphate cement vertebroplasty can effectively restore vertebral body mechanical strength, reduce height re-losst of the vertebral body and, Reduce the occurrence of internal fixation loosening, broken and some other complications, and the operation is simple and with high security.