经后路椎弓根内固定椎体成形治疗胸腰椎爆裂性骨折

TITLE transpedicular fixation combined with vertebroplasty for thoracolumbar burst fractures

目的 椎体成形术治疗胸腰椎爆裂性骨折预防术后形成“空心椎”、蛋壳椎引起的椎体塌陷、后凸畸形以及顽固性腰背痛和继发性神经损伤。方法 收治T11～L4胸腰椎暴裂性骨折患者 15例 ,年龄 2 4～ 78岁。短节段椎弓根复位固定复位后经伤椎通过椎弓根灌注HA/PMMA骨水泥 4～ 8ml。结果 随访 9～ 14月 ,均没有发生脊髓损伤加重。术前有不完全损伤的 13例 ,术后Frankel分级神经功能恢复 1级或以上 12例。伤椎前缘术前平均高度 16 .1cm ,术后随访 2 7.3cm。伤椎椎管内矢状径术前平均 7.1mm ,随访矢状径 18.1mm。矢状位恢复佳 ,矢状面指数 (SI) ,术前2 0度 ,术后 5度。结论 后路椎弓根内固定伤椎椎体内灌注生物活性骨水泥 ,即刻恢复伤椎强度和刚度 ,减少了后路内固定的应力 ,防止后凸畸形 ,减少并发症。

Objective To evaluate the efficacy of short-segment transpedicular fixation combined with bioactive cement vertebroplasty in preventing failure of short-segment fixation for the treatment of thoracolumbar burst fractures.Methods Fifteen patients, age 24-78,with thoracolumbar burst fractures were included. Short-segment transpedicular fixation combined with bioactive cement (HA/PMMA) vertebroplasty in injury vertebra. Clinical and radiologic outcomes were analyzed.Results The postoperative and preoperative sagittal index, percentage of anterior body height compression, was significantly different. And the data between the postoperative and follow-up were not significantly different.Conclusions Short-segment transpedicular instrumentation combined with bioactive cement vertebroplasty could decrease the rate of failure for thoracolumbar burst fractures.