AF内固定系统加骨水泥填塞治疗胸腰椎压缩骨折远期疗效

A long term effect of AF internal fixation system and polymethyl methacrylate plugging in treatment of thoracolumbar vertebral compression fractures

目的:应用AF内固定系统加骨水泥填塞治疗创伤后胸腰椎压缩骨折,与单纯采用AF的治疗进行比较,探讨胸腰椎压缩骨折有效的治疗方法。方法:采用AF脊柱内固定系统将56例胸腰椎骨折复位,同时行椎板或横突间植骨融合,其中21例患者在骨折椎体中注入骨水泥,X线检查评价临床效果。结果:56例患者照片示椎弓根钉位置满意,骨折复位良好,术后无神经根损伤及脊髓损伤加重情况,48例患者平均随访24个月,临床症状明显好转,X线照片提示有骨水泥填塞比没有骨水泥填塞的患者胸腰椎矫正度的丢失明显减少。脊柱骨折复位效果:无骨水泥组患者手术前、后Cobb角分别是(31±11)°和(4±4)°,差异有非常显著性意义(t=4.725,P<0.01);骨水泥组患者手术前、后Cobb角分别是(31±13)°和(4±4)°,差异有非常显著性意义(t=4.862,P<0.01)。无骨水泥对胸腰椎骨折后突畸形的矫正度是(26±9)°,骨水泥对后突畸形的矫正度是(27±10)°,骨水泥组与无骨水泥组在后突畸形的矫正度方面无显著性差异(t=1.65,P>0.01)。结论:采用AF内固定系统加骨水泥填塞治疗创伤后胸腰椎压缩骨折能有效维持椎体的高度,更好地防止后期脊柱后凸畸形的复发,减少远期并发症。

AIM:To investigate the therapeutic effects of AF internal system and polymethyl methacrylate(PMMA) plugging in the treatment of traumatic thoracolumbar vertebral compression fractures, and to compare it with the results of AF system alone.METHODS:The reduction of 56 thoracolumbar vertebral compression fractures was accomplished indirectly by distraction applied using AF spinal fixation device, and plus posterolateral or intertransverse process fusions.Among these patients,21 cases,15 males and 6 females with an average age of 32.6 years, were infused with PMMA into the fractured vertebral body, and the other 35 patients, 20 males and 15 females with an average age of 38.2 years, were treated with AF internal fixation only. X ray examined the patients in order to assess the clinical results. RESULTS:There were no nerve root injury and spinal cord injury worsen postoperative. Forty eight cases were followed up with the average period of twenty four months. Clinical symptoms of all cases were much better than preoperative. X rays showed that the loss of correction degrees of thoracolumbar vertebra in the cases with PMMA plugging was less than the cases without PMMA (P< 0.01).The angles of Cobb were (31± 11)° and (4± 4) ° in the case without PMMA, and (31± 13)° and (4± 4)° in the cases with PMMA respectively before and after treatment, both with a significant difference(t=4.725,P< 0.01;t=4.862, P< 0.01). The correlative angles were(26± 9) ° for the cases without PMMA and(27± 10 )° for the cases with PMMA, and there was insignificantly different between the two groups (t=1.65,P >0.01).