经椎弓根伤椎撬拨复位植骨治疗胸腰段脊柱骨折

Transpedicular porking and grafting for the treatment of thoracolumbar spinal fracture

目的:探讨椎弓根伤椎终板撬拨复位器、去螺纹器及椎体内植骨器在治疗胸腰椎段脊柱骨折的应用。方法:自2008年3月至2011年3月收集32例胸腰椎骨折,其中男17例,女15例;年龄25～65岁,平均39.4岁。采用自行设计的经椎弓根终板撬拨复位器、去螺纹器及椎体植骨器行椎体终板复位及椎体内植骨,短节段椎弓根内固定。全部病例要求术前、术后1周、术后1年及内固定取出后3个月行伤椎X线片及CT检查,然后测量伤椎矢状面、额状面后突角度及伤椎高度。结果:32例患者均获得随访,时间14～21个月,平均16个月。随访内容包括后突角度和椎体高度的丢失、骨折愈合情况和内固定植入情况。32例均未出现植骨操作引起的神经、血管并发症,椎体内植骨融合良好。术前、术后1周、术后1年及内固定取出后3个月的统计结果显示伤椎椎体高度保持良好,未出现复位后高度、角度丢失和后期塌陷。结论:采用经椎弓根伤椎终板撬拨复位、去螺纹器及椎体植骨器行椎体终板复位及椎体内植骨治疗胸腰椎骨折能取得满意疗效,而且创伤小,椎体内植骨可促进骨折早期愈合,恢复椎体高度,重建脊柱的稳定性,预防术后晚期椎体高度及角度的丢失,避免了前路手术。

Objective：To investigate the application of transpedicular porking repositor,thread device and transpedical interbody bone grafting apparatus in the treatment of thoracolumbar spinal fracture. Methods：From March 2008 to March 2011,17 males and 15 females with thoracolumbar spinal fracture were treated by using self-designed transpedicular porking reposito,thread device and transpedical interbody bone grafting apparatus. The average age was 39.4 years（ranged from 25 to 65 years）. All the cases were checked by X-ray and CT before and one week,one year after operation,removal of internal fixation. The angle of injured vertebral sagittal,cobbs angle and injured vertebral height were measured. Results：All patients were followed up,and the duration ranged for 14 to 21 months （averaged 16 months）. The content of following up included loss of ithycyphos and height of spinal,fracture healing and implant fixation. Nerve vascular complication caused by implantation didn＇t occurred;interverbral body fusion was good. The results preoperative,1 week and year postoperative and 3 months after taking out the internal fixation showed injured spinal height maintained well,loss and collapse of height and angle did not occurred. Conclusion：Treating thoracolumbar spinal fracture can obtained satisfactory effects by using transpedicular porking repositor,thread device and transpedical interbody bone grafting apparatus. It has advantages of minimal invasive,and can promote fracture healing earlier,recover spinal height,rebuild stability of spinal,prevent loss and collapse of vertebral body height to avoid anterior lumbar surgery on the late stage.