球囊复位终板椎体增强结合经皮椎弓根螺钉固定治疗胸腰椎爆裂性骨折

Balloon-assisted endplate reduction reinforced by injectable calcium sulfate cement combined with percutaneous pedicle screwing for thoracolumbar burst fractures

目的探讨球囊复位终板硫酸钙椎体增强结合经皮椎弓根螺钉固定治疗胸腰椎爆裂性骨折的疗效。方法回顾性分析2016年1月至2018年12月期间合肥市第二人民医院骨科收治的23例载荷分享评分>6分的胸腰椎爆裂性骨折患者资料。男14例,女9例;年龄为20~60岁,平均43岁。采用经皮椎弓根螺钉附加伤椎置钉复位、固定,再通过经皮球囊复位伤椎塌陷的终板,推注注射型硫酸钙骨水泥(CSC)。记录患者的手术时间、术中出血量、骨折愈合、疼痛视觉模拟评分(VAS)、伤椎前缘高度比、伤椎中部高度比、矢状面cobb角、CSC吸收及并发症发生情况等。结果本组患者的手术时间平均为110 min;术中出血量平均为75 mL。23例患者术后获12~48个月(平均24个月)随访。CSC平均在3个月内完全吸收。23例患者术后3 d及末次随访时腰背部疼痛VAS评分[(2.1±0.9)、(1.1±0.3)分]均较术前[(7.8±1.3)分]显著改善,术后1周、3个月及末次随访时伤椎前缘高度比(93.22%±6.39%、92.79%±6.41%、92.38%±6.60%)、伤椎中部高度比(90.66%±6.28%、89.92%±6.05%、86.54%±6.96%)、矢状面cobb角(4.88°±2.35°、5.32°±2.34°、5.84°±2.43°)也均较术前(51.68%±8.32%、63.37%±9.24%、20.77°±7.35°)显著改善,差异有统计学意义(P<0.05);而术后各时间点之间比较差异无统计学意义(P>0.05))。随访期间无一例患者发生内固定物松动、断裂及后凸cobb角丢失达10°以上。结论球囊复位终板硫酸钙椎体增强结合经皮椎弓根螺钉固定治疗载荷分享评分>6分的胸腰椎爆裂性骨折安全、微创,可有效复位塌陷的伤椎终板和恢复伤椎力学性能。

Objective To investigate the clinical results of percutaneous balloon-assisted endplate reduction reinforced by injectable calcium sulfate cement(CSC)after fixation with percutaneous pedicle screws in the treatment of thoracolumbar burst fractures.Methods From January 2016 to December 2018,23 patients were treated at Department of Orthopaedics,The Second People's Hospital of Hefei for thoracolumbar burst fractures without neural impairment(LSC>6).They were 14 males and 9 females,aged from 20 to 60 years(average,43 years).After reduction and fixation of the injured vertebrae with percutaneous pedicle screws,the collapsed endplates were reset by transpedicular balloon and reinforced by injectable CSC.Recorded were operation time,bleeding volume,fracture healing,visual analogue scale(VAS),anterior height ratio of the injured vertebra,central height ratio of the injured vertebra,sagittal cobb angle,absorption of CSC and complications.Results The operation time averaged 110 min and the bleeding volume 75 mL.This group of patients obtained follow-up for 12 to 48 months(average,24 months).The mean time for CSC complete absorption was 3 months postoperatively.The VAS scores for back pain at 3 days postoperation and the last follow-up(2.1±0.9 and 1.1±0.3)were significantly improved than the preoperative value(7.8±1.3);the anterior height ratios of the injured vertebra(93.22%±6.39%,92.79%±6.41%and 92.38%±6.60%),the central height ratios of the injured vertebra(90.66%±6.28%,89.92%±6.05%and 86.54%±6.96%)and the sagittal cobb angles(4.88°±2.35°,5.32°±2.34°and 5.84°±2.43°)at postoperative 1 week,3 months and the last follow-up were significantly improved than the preoperative values(51.68%±8.32%,63.37%±9.24%and 20.77°±7.35°,respectively)(P<0.05),but there was no significant difference between the 3 time points(P>0.05).Internal fixation failure or loss of cobb angle greater than 10°was found in none of the patients.Conclusions Percutaneous balloon-assisted endplate reduction reinforced by injectable CSC combined with percutaneous pedicle screwing is a safe and minimally invasive treatment of thoracolumbar burst fractures with LSC>6,leading to effective reduction of the collapsed endplate and restoration of vertebral mechanical performance.