活性骨水泥经后路椎体成形治疗老年性胸腰椎爆裂性骨折

TITLE treatment for gerontic thoracolumbar burst fractures with transpedicular fixation combined with bioactive cement vertebroplasty

目的 :手术治疗老年性骨质疏松性胸腰椎爆裂性骨折。方法 :经后路椎弓根短节段复位固定 ,伤椎内灌注聚甲基丙烯酸甲酯 /羟基磷灰石组成的复合活性骨水泥。结果 :收治老年性T11～L4胸腰椎爆裂性骨折患者 13例 ,平均年龄 67岁。均合并神经损害 ,椎体压缩 1/ 3的 3例 ,1/ 2以上 10例 ,椎管内矢状径受压 >1/ 3以上 ,术中术后均无脊髓损伤加重。随访 11～ 18个月 ,术后Frankel分级神经功能恢复 1级或以上 9例 ,术前Frankel2级 1例 ,术后无变化。伤椎恢复高度无明显丢失 ,无椎间隙塌陷 ,无内固定断裂或弯曲、松动。结论 :在老年性或合并有骨质疏松的椎体爆裂性骨折时采用后路椎弓根内固定伤椎椎体成形 ,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.Method:Thirteen patients,aged 61～78,with thoracolumbar burst fractures were included.Short-segment transpedicular fixation combined with bioactive cement (HA/PMMA) vertebroplasty in injured vertebra.The inclusion criterion was the presence of fractures through the T_ 11 ～L_4 vertebrae with neurologic compromise.Clinical and radiologic (sagittal index,percentage of anterior body height compression,and local kyphosis) outcomes were analyzed.Result:The postoperative and preoperative sagittal index,percentage of anterior body height compression,was significantly different.And that of loss in local kyphosis between the postoperative and follow-up were not significantly different.Conclusions:Short-segment transpedicular instrumentation of gerontic thoracolumbar burst fractures is associated with a low rate of failure that can be decreased by combined with bioactive cement vertebroplasty.