椎体成形内固定术治疗胸腰椎单椎体骨折  

Treatment on thoracolumbar single-vertebra fracture by combining transpedicular spongiosaplasty and internal fixation

作　　者：叶秀益[1] 王如林[2] 韩成钢[2] 徐婧[2] 

机构地区：[1]宁波大学医学院骨外科,浙江宁波315020 [2]宁波大学医学院附属医院脊柱一科,浙江宁波315020

出　　处：《临床骨科杂志》2009年第5期484-486,共3页Journal of Clinical Orthopaedics

摘　　要：目的探讨椎体植骨成形和短节段椎弓根螺钉内固定治疗胸腰椎骨折的疗效。方法52例胸腰椎单椎体不稳定骨折均采用椎弓根螺钉内固定治疗,24例行经椎弓根植骨椎体成形术(TPG),28例行脊柱后外侧植骨融合术(PLF)。对两组患者手术前后的X线片、CT和神经功能恢复进行比较。结果术后1周TPG组伤椎前(后)缘高度、Cobb角、椎管矢状径占位分别平均为95.7%(98.3%)、5°、9.7%,PLF组上述指标为96.3%(96.9%)、6°、11.3%,两组术后脊髓神经功能均有不同程度恢复。两组上述指标在术后1周改善无统计学意义(P>0.05)。52例均获随访,时间5～36个月,两组术后脊髓神经功能均有不同程度恢复。末次随访PLF组术后矫正有不同程度的丢失,并有21.4%的内固定失效率,TPG组未发现明显的矫正丢失及内固定失效,TPG组远期疗效优于PLF组(P<0.05)。结论椎体植骨成形内固定术增加伤椎骨质量,提高椎体生物力学强度,恢复脊柱力线,保留更多脊柱运动节段,减少后期矫正度丢失、内固定失效及邻近节段退变的发生。Objective To explore the clinical efficacy of combining short-segment pedicle screw fixation and transpedicular grafting vertebroplasty with reconstituted bone xenograft（RBX） on thoracolumbar fracture.Methods 52 cases with thoracolumbar single-vertebra fractures were recruited,of which 24 cases treated with transpedicular grafting vertebroplasty（TPG group）were compared to 28 cases treated with posterolateral fusion（PLF group） according to clinical outcome,X-ray and CT examination data before and after operation.Results One week after operation,anterior（posterior） height of the injured vertebra,Cobb＇s angle and occupation of sagittal diameter of vertebral canal were averagely restored to 95.7%（98.3%）,5°and 9.7% in TPG group,the relevant indexes in PLF group were 96.3%（96.9%）,6°and 11.3%,respectively.Above-mentioned radiological measurements had no significant difference（P〉0.05） between two groups.With a follow-up period of 5 to 36 months,all cases were improved for ASIA grades respectively in two groups.At the last follow-up days,it showed a significant loss of correction,higher rates of internal fixation failure in PLF group.TPG group was obviously better than PLF group（P〈0.05）.Conclusions Transpedicular RBX grafting vertebroplasty and internal fixation can not only recuperate the normal bone construction,improve the biomechanics intensity of injured vertebrae and restore the spinal alignment with saving more movement segments but also reduce the incidence of missing of rectification degrees,internal fixation failure and adjacent segment degeneration.

关 键 词：脊柱骨折 经椎弓根椎体成形术 邻近节段退变 

分 类 号：R683.2[医药卫生—骨科学] R687.3[医药卫生—外科学]