骨水泥充填技术治疗胸腰椎爆裂性骨折

Treatment for thoracolumbar spinal burst fracture in youth and middle-aged adults by bone cement filling

目的：探讨将医用骨水泥灌注进骨折椎体内以充填骨折间隙的方法用于治疗青壮年胸腰椎爆裂性骨折的可行性、安全性及远期效果。方法：对50例年龄在30~55岁的胸腰椎爆裂性骨折且椎体高度丢失40%~70%合并部分瘫痪或无瘫痪的患者先行后路椎弓根螺钉置入及撑开复位，必要时行椎管探查减压；然后经骨折椎体一侧椎弓根放置灌注骨水泥所需的工作套管，在透视监视下推注适量的骨水泥进入骨折块之间的空隙内均匀分布充填。手术后行X线片和CT片扫描并定期随访。结果：50例中有5例发生骨水泥渗漏，其中1例从前方漏出，2例从侧方漏出，2例经终板裂隙漏入椎间盘内，均无相关的临床症状出现。未发生椎管内或血管渗漏。随访时间5~10年（平均7.5年），X线片和CT片显示骨折椎体高度无丢失，椎体内无残留空隙，未见“骨水泥–椎体”之间有分离界面形成。骨折局部未出现后凸畸形。50例患者中15例形成骨折椎体和上、下椎体之间牢固的骨桥连接。50例患者在末次随访时均未见内固定松动断裂。结论：后路复位固定联合伤椎内灌注骨水泥充填的术式治疗青壮年胸腰椎爆裂性骨折是安全可行的、可以有效充填骨折椎体内的大的间隙而获得即刻及永久的稳定性，因而具有良好的近期及远期效果。

Objective： To verify whether the procedure of posterior instrumentation and vertebroplasty for treatment of thoracolumbar burst fracture in youth and middle-aged patients is safe, practical and effective in short- and long-term. Methods： A total of 50 patients aged 30–55 years old who suffered from thoracolumbar burst fracture complicated with incomplete paralysis or without neurologic symptom received surgery by using pedicle-screw implantation, reduction and bone cement filling through the unilateral or bilateral pedicles. The bone cement injection was conducted slowly and cautiously under monitor of fluoroscopy. Spinal canal exploration or decompression was performed regularly in follow-ups by X-ray films and CT scans. Results： Cement leakage occurred in 5 cases without relevant symptom, including 1 case with leak from anterior aspect, 2 cases from lateral aspect, and 2 cases through ruptured end-plate into disc space. No spinal canal leakage or introvascular leakage was detected. The following-up duration was 5 to 10 years. There was no vertebral body height loss and regional kyphosis. The gaps within fractured vertebral body prior to surgery were disappeared completely. There was also no cement-bone interface detected. In 15 out of 50 cases, there were newly-formed bone bridges between fractured vertebral body and upper or lower adjacent vertebral body. There was no hardware failure occurred up to final follow-up. Conclusion： Bone cement filling combined with posterior instrumentation through pedicle-screw technique is a safe, practical and effective method for treatment of non-osteoporotic thoracolumbar spinal burst fractures without severe neurologic injury. The gaps among fracture fragments can be filled evenly and completely. Therefore, instant and permanent spinal stability can be achieved with excellent long-term result.