球囊扩张椎体成形结合短节段椎弓根螺钉固定治疗胸腰椎爆裂性骨折

BALLOON VERTEBROPLASTY COMBINED WITH SHORT-SEGMENT PEDICLE SCREW INSTRUMENTATION FOR TREATMENT OF THORACOLUMBAR BURST FRACTURES

目的 探讨球囊扩张椎体成形结合短节段椎弓根螺钉固定治疗胸腰椎爆裂性骨折的近期疗效。方法 2011年6月-2013年12月,收治22例胸腰椎爆裂性骨折。其中男14例,女8例;年龄20～60岁,平均42.5岁。损伤节段：T111例,T124例,L110例,L26例,L31例。骨折AO分型：A型13例,B型9例。按Frankel脊髓神经功能障碍分级标准：C级2例,D级3例,E级17例。受伤至手术时间3～10 d,平均5.5 d。采用经伤椎椎弓根螺钉复位、固定,再通过球囊扩张复位伤椎塌陷终板并注入可注射型硫酸钙骨水泥治疗。术后评估伤椎前缘高度比、伤椎中部高度比、矢状面Cobb角、神经功能恢复及内固定失败情况。结果 术后1例切口浅表坏死、1例切口渗出液较多,均经相应处理后愈合;其余患者切口均Ⅰ期愈合。22例均获随访,随访时间9～40个月,平均15个月。术后2例发生CSC渗漏,均无临床症状出现。术后8周开始出现CSC吸收现象,12～16周吸收完全,平均13.2周。骨折愈合时间16～20周,平均18.5周。术后1周、3个月及末次随访时,伤椎前缘高度比、伤椎中部高度比、矢状面Cobb角均较术前显著改善（P〈0.01）,术后各时间点间差异无统计学意义（P〉0.01）。无1例发生内固定物松动、断裂,无后凸Cobb角丢失〉10°者;无脊髓神经功能损害及加重。结论 球囊扩张椎体成形结合短节段椎弓根螺钉固定治疗胸腰椎爆裂性骨折简便、安全,可有效提高伤椎复位质量和恢复椎体力学性能,明显减少矫正度丢失和内固定失败。

Objective To investigate the short-term effectiveness of balloon vertebroplasty combined with short- segment pedicle screw instrumentation for the treatment of thoracolumbar burst fractures. Methods Between June 2011 and December 2013, 22 patients with thoracolumbar burst fractures were included. There were 14 males and 8 females, aged 20-60 years （mean, 42.5 years）. The fracture segments included Tn in 1 case, T12 in 4 cases, L1 in 10 cases, L2 in 6 cases, and L3 in 1 case. According to AO classification system, there were 13 cases of type A and 9 cases of type B. Spinal cord injury was classified as grade C in 2 cases, grade D in 3 cases, and grade E in 17 cases according to Frankel scale. The time from injury to operation was 3-10 days （mean, 5.5 days）. All patients underwent posterior reduction and fLxation via the injured vertebra, transpedicular balloon reduction of the endplate and calcium sulfate cement （CSC） injection. The ratio of anterior vertebral height, the ratio of central vertebral height, the sagittal Cobb angle, the restoration of nervous function, and internal fLxation failure were analyzed. Results except 2 cases of poor healing, which was cured after dressing up 9-40 months （mean, 15 months）. CSC leakage occurred in 2 Primary healing of incision was obtained in the others change or debridement. All the patients were followed cases. Absorption of CSC was observed at 8 weeks after operation with complete absorption time of 12-16 weeks （mean, 13.2 weeks）. The mean fracture healing time was 18.5 weeks （range, 16-20 weeks）. The ratio of anterior vertebral height, ratio of central vertebral height, and sagittal Cobb angle were significantly improved at 1 week and 3 months after operation and last follow-up when compared with preoperative values （P〈0.01）, but no significant difference was found among 3 time points after operation （P〉0.01）. There was no internal fixation failure or Cobb angle loss more than 10°. Frankel scale was improved with no deterioration of neurologic function injury. Conclusion Balloon vertebroplasty combined with short-segment pedicle screw instrumentation is simple and safe for the treatment of thoracolumbar burst fractures, and it can improve the quality of reduction, restore vertebral mechanical performance effectively, and prevent the loss of correction and internal ftxation failure.