过伸体位下矫形结合椎体内植骨治疗新鲜胸腰段椎体骨折

Pedicle fixation combined with transpedicular bone grafting for the treatment of fresh thoracolumbar vertebral fractures

目的探讨过伸体位下椎弓根内固定系统矫形结合伤椎椎体内植骨技术治疗新鲜胸腰段椎体骨折的技术要点及临床疗效。方法 2010年1月-2013年1月,对76例胸腰段椎体新鲜骨折患者,在过伸体位下采用椎弓根内固定系统矫形并伤椎椎体内植骨治疗,术后8~12个月取出内固定。结果手术时间45~92min,平均65 min;出血量50~380 ml,平均186 ml。无感染、继发性脊髓神经损伤或内固定松动断裂等并发症。术后伤椎前缘高度及后凸畸形较术前明显恢复,差异有统计学意义（P〈0.01）;伤椎前缘高度及后凸Cobb角在术后各时间点间比较无统计学意义（P〉0.05）;腰背疼痛视觉模拟评分术后较术前明显降低,差异有统计学意义（P〈0.01）,在术后各时间点间比较差异无统计学意义（P〉0.05）。结论过伸体位下应用椎弓根内固定系统矫形结合伤椎椎体内植骨技术治疗新鲜胸腰段椎体骨折,可有效的恢复椎体前缘高度、预防椎体高度远期的丢失,是一种治疗新鲜胸腰段椎体骨折较好的方法。

[Objective]To discuss the technical points and clinical efficacy of hyperextension postural reduction technique combined with transpedicular bone grafting technique in the treatment of fresh thoracolumbar vertebral fractures.[Method]2010 January to 2013 January, 76 patients with cases of fresh thoracolumbar vertebral fracture,under general anesthesia with extreme spinal hyperextension, for pedicle fixation and vertebral body bone graft treatment, 8 ~ 12 months after surgery to remove the internal fixation. [Results]The operation time was 45 ~ 92 min,bleeding volume was 50 ~300 ml. No wound infection, secondary spinal cord injury, internal fixation loosening and breakage. Postoperative vertebral body height and kyphosis significantly compared with the preoperative recovery,the difference was statistically significant（P〈0.01）; vertebral front height and kyphosis Cobb angle at various postoperative time points showed no statistical significance（P〉0.05）. The lumbar back pain visual analog scale was significantly lower than the preoperative. The difference was statistically significant（P〈0.01）, at various postoperative time points showed no statistical significance（P〉0.05）.[Conclusion]Application of hyperextension of postural reduction technique combined with vertebral body bone graft technique in the treatment of fresh thoracolumbar vertebral fractures can effectively restore anterior vertebral height, Prevention of the loss of vertebral height,？is a good method for the treatment of fresh thoracolumbar vertebral fractures.