球囊扩张椎体成形与椎弓根钉置入内固定治疗胸腰椎爆裂骨折的效果对比

Effectiveness between kyphoplasty and pedical screw fixation for treatment of thoracolumbar burst fractures

背景:由于爆裂骨折后椎体后壁不完整,失去了对灌注骨水泥的阻挡保护,胸腰椎爆裂骨折因此成为椎体成形的相对禁忌证。然而在临床过程中常会遇到爆裂骨折患者伴有严重的内科疾病而不能耐受常规的切开复位内固定,此时微创椎体成形可能是患者的惟一选择。目前关于胸腰椎爆裂骨折采用微创椎体成形和椎弓根钉内固定治疗的对比研究还不多。目的:对比观察采用椎弓根钉置入内固定和微创椎体成形治疗胸腰椎爆裂骨折的效果。方法:北京大学第一医院骨科2005-09/2008-10纳入27例胸腰椎爆裂骨折患者,其中12例开展微创椎体成形治疗,15例采用椎弓根钉内固定治疗。对比观察两组病例的手术时间、治疗后疼痛缓解情况、术中及治疗后不良事件。结果与结论:椎弓根钉置入内固定组手术时间平均55min,固定后5～7d疼痛缓解,疼痛缓解率平均为69.3%,无神经根损伤。球囊扩张椎体成形组手术时间平均37min,治疗后第1日疼痛即出现缓解,疼缓解率平均为86.2%,有3例骨水泥渗漏,但均无神经症状。提示胸腰椎爆裂骨折采用椎弓根钉置入内固定和微创球囊扩张椎体成形均可达到缓解疼痛稳定骨折的目的,采用椎弓根钉内置入固定手术时间长,创伤大;而微创椎体成形术的创伤小、手术时间短,但有一定的骨水泥渗漏危险。虽然胸腰椎爆裂骨折是椎体成形的相对禁忌证,但通过合理使用微创椎体成形术技术,可减少骨水泥的渗漏,从而为爆裂骨折的治疗提供一个新的选择。

BACKGROUND： Following burst fractures, the vertebral posterior wall is not complete, and cannot stop bone cement perfusion. Therefore, thoracolumbar burst fracture has become contraindication of kyphoplasty. However, the patients with thoracolumbar burst fracture are always complicated with severe internal diseases, and cannot undergo conventional open reduction and internal fixation. Minimally invasive kyphoplasty may be the only choice for them. Currently, there are few reports regarding kyphoplasty and pedical screw fixation for treatment of thoracolumbar burst fractures. OBJECTIVE： To compare the effectiveness between kyphoplasty and pedical screw fixation for treatment of thoracolumbar burst fractures. METHODS： A total of 27 patients with thoracolumbar burst fractures were selected from Department of Orthopedics, Peking University First Hospital between September 2005 and October 2008, including 12 cases treated with kyphoplasty and 15 treated with pedical screw fixation. The operating time, the effect and time of pain relief, the complication in operation and postoperation were evaluated. RESULTS AND CONCLUSION： The mean operating time of pedical screw fixation group was 55 minutes, pain relief was detected on the 5th-7th days postoperatively with a mean relief rate of 69.3%; there was no neural complication in pedical screw fixation group. The mean operating time of kyphoplasty group was 37 minutes, pain was relieved on the first day postoperatively with a mean relief rate of 86.2%; 3 cases developed bone cement leakage but no neural complication in kyphoplasty group. The purpose of pain relief can all be obtained by kyphoplasty and pedical screw fixation for treatment of thoracolumbar burst fractures, the mean operating time of pedical screw fixation group is longer than that of kyphoplasty group, but bone cement leakage in kyphoplasty group should be considered. Kyphoplasty may be a new choice for thoracolumbar burst fractures.