胸腰椎骨折后路内固定术后并发椎体真空征的临床分析

Analysis of concurrent intravertebral vacuum sign in thoracolumbar fractures after posterior internal fixation

目的:分析胸腰椎骨折术后出现椎体内真空征、椎体塌陷以及假关节形成等术后并发症的原因,探讨TLICS分型对胸腰椎骨折术式选择的重要性。方法:对2006年1月至2010年12月手术治疗的15例胸腰椎骨折患者术后出现并发症的病例进行回顾性分析。其中男9例,女6例;年龄18～75岁,平均54.6岁。骨折部位:T127例,L15例,L23例。骨折类型:压缩性骨折12例,爆裂性骨折3例。按TLICS法分型:Ⅰ型12例,Ⅲ型3例。根据患者术后的临床表现以及影像学表现,并结合国内外文献的研究报道分析胸腰椎骨折单纯后路内固定术后出现椎体并发症的原因。结果:15例均获随访,时间10～20个月,平均15个月,发现内固定失败,椎体高度再丢失9例(椎体塌陷4例,其中3例出现螺钉松动),出现空壳征6例。结论:胸腰椎骨折术前应仔细全面的评估患者情况,严格掌握其术式的适应证,依照正确的分型选择正确的手术入路,尤其重视脊柱前中柱稳定性的重建,避免椎体真空征的出现及内固定的失败。

Objective：To investigate the importance of TLICS classification to surgical options of thoracolumbar fractures by analyzing the cause of intravertebral vacuum sign,vertebral collapse and vertebral pseudarthrosis.Methods：From January 2006 to December 2010,the clinical data about 15 patients with postoperative complications by thoracolumbar fracture after posterior internal fixation were retrospectively analyzed.There were 9 males and 6 females,ranging in age from 18 to 75 years,with an average of 54.6 years.Of them,fracture site in T12 was 7 cases,L1 was 5 cases,L2 was 3 cases;compression fractures was in 12 cases and burst fracture was in 3 cases;according to classification of TLICS,12 cases were of typeⅠ,3 cases of typeⅢ.And the causes of complications after posterior fixation were analyzed according clinical manifestation and imaging finding combined with review literatures.Results：After 10 to 20 months following-up（with average of 15 months）,loss of vertebral height found in 9 cases（4 cases existed vertebral collapse,as well as 3 cases occurred screw loosening）and Intravertebral Vacuum Sign appeared in 6 cases.Conclusion：In order to avoid the vertebral vacuum and fixation failure,the clinical data of patients should be roundly and carefully evaluated,surgical indications should be strictly controlled and the surgical approach should be selected according to correct classification.Particularly,the reconstruction of the stability of former spinal column shoud be paid more attention.