椎弓根钉固定结合注射性硫酸钙椎体成形术治疗胸腰椎骨折  

Treatment of thoracolumbar fractures with pedicle screw fixation and calcium sulfate cement vertebroplasty

作　　者：张绍东[1] 吴小涛[1] 杨惠林[2] 唐天驷[2] 陈辉[1] 蒋赞利[1] 茅祖斌[1] 孔翔飞[1] 王宸[1] 

机构地区：[1]东南大学附属中大医院骨科,南京210009 [2]苏州大学附属第一医院骨科

出　　处：《中华创伤骨科杂志》2007年第3期225-228,共4页Chinese Journal of Orthopaedic Trauma

基　　金：江苏省卫生厅“135工程”重点学科开放课题（K0618）

摘　　要：目的探讨椎弓根钉复位固定结合注射性硫酸钙（CSC）椎体成形术治疗胸腰椎骨折的方法和疗效。方法自2004年6月～2005年6月，对21例胸腰椎骨折采用椎弓根钉复位、固定后，再通过椎弓根将伤椎塌陷终板骨块推顶复位，灌注可注射性CSC行椎体成形术的治疗方法。术后随访并评估此方法的临床疗效。结果平均每个椎体灌注CSC5．5mL；2例术中发生椎管内渗漏，漏出呈液态，术后患者无神经症状加重；根据影像学评估，随访时测得Cobb角、椎体前缘高度比值[分别为6．7°±8．1°，（76．7±6．9）％]与术前[分别为21．6°±6．5°，（44．9±2．1）％]比较，差异有统计学意义（P〈0．05），而与术后即刻[分别为6．2°±8．9°，（78．3±7．7）％]比较，差异无统计学意义（P〉0．05）。经8～14个月（平均11．5个月）随访，无椎弓根钉失败病例。结论椎弓根钉复位、固定后采用可注射性CSC行椎体成形术操作简单，无椎管内占位及栓塞等并发症发生，安全性高，可有效恢复椎体力学性能，减少单纯椎弓根钉固定后断钉及椎体高度再丢失等并发症。Objective To investigate surgical techniques and clinical results of pedicle screw fixation and calcium sulfate cement （CSC） vertebroplasty in treatment of thoracolumbar fractures. Methods From June 2004 to June 2005, 21 patients with thoracolumhar fracture were treated with short-segment pedicle screw fixation, reduction of the endplate and reinforcement of the injured vertebra with injectable CSC. Results CSC leakage occurred in 2 patients who experienced no worsening neurologic symptoms after surgery. The average CSC filling volume was 5.5 mL for one vertebra. There were significant differences in the kyphotic Cobb angle and ratio of anterior vertebral height between their postoperative and preoperative radiological measurements. Follow-up showed no significant deformity in the angle and ratio after surgery. There was no pedicle screw failure in the follow-up period of 8 months to 14 months. Conclusions CSC vertebroplasty combined with pedicle screw fixation is simple and safe, and unlikely to result in CSC leakage, embolism or other complications like pedicle screw failure and loss of vertebral height. After CSC vertebroplasty, vertebral mechanical performance can be restored effectively.

关 键 词：胸椎 腰椎 骨折 椎体成形术 硫酸钙 并发症 

分 类 号：R686[医药卫生—骨科学]