硫酸钙椎体成形术联合椎弓根钉内固定治疗创伤性胸腰椎骨折的前瞻性研究

A prospective study of pedicle screw fixation combined with calcium sulfate cement vertebroplasty for treatment of traumatic thoracolumbar fractures

目的探讨注射型硫酸钙椎体成形术联合椎弓根钉内固定治疗创伤性胸腰椎骨折的初步临床疗效。方法自2008年3月-2010年5月。采用注射型硫酸钙椎体成形术联合后路短节段椎弓根钉内固定治疗25例无神经障碍的创伤性胸腰椎骨折，术后随访观察椎体前、中部的相对高度、Cobb角、伤椎角。并对疼痛和功能指标分别用视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI）进行量化比较。结果23例得到随访13—35个月。平均23．8个月。术后1周时椎体前、中部的相对高度、Cobb角，伤椎角分别与术前值比较，差异有统计学意义（P〈O．05）。而与末次随访时比较，差异无统计学意义（P〉0．05）。结论硫酸钙椎体成形术联合椎弓根钉内固定治疗创伤性胸腰椎骨折可以有效防止内固定失败和矫正度丢失。临床效果满意。

Objective To evaluate the clinical results of short-segment posterior instrumentation combined with calcium sul- fate cement （CSC）vertebroplasty for the treatment of traumatic thoracolumbar fractures. Methods Twenty five patients with traumatic thoracolumbar fractures without neurelogic deficit were treated with CSC vertebroplasty in combination with a short- segment posterior fixation.Twenty three patients were followed for at least one year. X-rays were taken to evaluate vertebral height, local Cobb angle, and the vertebral angle. Pain was measured using the Visual Analogue pain Scale （VAS）. Disability was measured using the Oswestry Disability Index（ODI）. Results Twenty three patients followed up for 13 to 35 months,with an average of 23.8 month.There were significant differences in the kyphotic angle and ratio of vertebral height between their postoperative and preoperative radiologieal measurements（P 〈0.05 ）. Follow-up showed no significant vertebral height loss and deformity after surgery （P 〉0.05）. Conclusion The combination of both surgical techniques is able to restore and maintain vertebral height and correction of angular deformity. This technique might offer an ideal method for the treatment of traumatic thoracolumbar fractures.