后路经椎弓根硫酸钙骨替代材料椎体内填充治疗胸腰椎压缩骨折

Treatment of thoracolumbar fractures with posterior transpedicular instrumentation of artificial bone graft and vertebral pedicle screw in fractured vertebra

目的 探讨腰椎后入路切开复位椎弓根螺钉固定联合经椎弓根硫酸钙骨替代材料椎体内填充治疗胸腰椎压缩骨折的临床疗效.方法 回顾性分析2010年1月—2011年10月接受后路复位椎弓根钉内固定联合硫酸钙骨替代材料椎体内填充治疗的18例胸腰椎压缩骨折患者的临床资料.比较患者术前、术后影像学改变,以及术前和末次随访时Cobb角、Oswestry功能障碍指数（ODI）变化.结果 18例患者随访14 ～24个月,平均（18±2）个月,无并发症发生,无螺钉断裂、松动.椎体前柱前缘高度术前为（18.69±2.59）mm,术后为（26.43±1.94）mm;中柱前缘高度术前为（21.05±2.85）mm,术后为（26.16±1.25）mm;术前Cobb角16.44°±3.07°,末次随访为2.89°±1.28°;术前ODI为82.38％ ±7.02％,末次随访为17.14％ ±7.53％.各观察项目术前、术后比较,差异均有统计学意义（P值均＜0.01）.结论 后路椎弓根钉固定结合硫酸钙骨替代材料填充治疗胸腰椎压缩骨折,可有效恢复椎体高度,避免椎体高度丢失.

Objective To study the clinical curative effect of posterior transpedicular instrumentation of artificial bone graft and vertebral pedicle screw in fractured vertebra for the treatment of thoracolumbar fractures.Methods From January 2010 to October 2011,18 cases with thoracolumbar fractures were treated with short segmental transpedicalar fixation combined with transpedicular instrumentation of artificial bone graft and vertebral pedicle screw in fractured vertebra.The changes of the height of anterior border of anterior horn and the height of anterior border of axial column were observed before and after operation respectively.The changes of Cobb angle and Oswestry disability index（ODI） were evaluated before operation and at the final follow-up.Results Eighteen cases were followed up for 14-24months （averaged 18 months）.There was no complication.The height of anterior border of anterior horn which was（18.69 ± 2.59） mm before operation reached to （26.43 ± 1.94） mm after operation,and the height of anterior border of axial column was enhanced from （21.05 ± 2.85） mm before operation to （26.16 ± 1.25 mm） after operation.The Cobb angle which was 16.44° ± 3.07 ° before operation reached to 2.89° ± 1.28° at the last follow-up,and the ODI was reduced from 82.38% ± 7.02% before operation to 17.14% ± 7.53% at last follow-up.There were significantly statistical differences in the observation items between before and after operation（all P values 〈 0.01）.Conclusions In the treatment of thoracolumbar fractures,the method of transpedicular fixation combined with transpedicular artificial bones graft in fractured vertebra can restore the height of fractured vertebra,and reduce internal fixation failure.