后路椎弓根钉结合椎体成形治疗胸腰椎爆裂骨折  

Posterior short -segment pedicle screw fixation combined with vertebroplasty for the treatment of thoracolumbar burst fractures

作　　者：陈之青[1,2] 谢金兔[1,2] 顾晓民[1,2] 谢国盛[1,2] 胡大鹏[1,2] 王荣[1,2] 陆建民[1,2] 

机构地区：[1]杭州师范大学附属医院 [2]杭州市第二人民医院骨科,浙江杭州310015

出　　处：《中国骨伤》2010年第2期102-106,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨后路椎弓根钉固定结合终板撑开钳复位终板、自固化磷酸钙骨水泥椎体成形治疗胸腰椎爆裂骨折的临床价值。方法:采用后路椎弓根螺钉内固定结合经椎弓根终板撑开钳复位中央终板、自固化磷酸钙骨水泥椎体成形治疗胸腰椎骨折爆裂患者30例(32个椎体),男22例,女8例;年龄25～71岁,平均47岁。骨折节段:T111椎,T125椎,L114椎,L28椎,L32椎,L41椎,L51椎。按Denis分型:A型4椎,B型25椎,C型1椎,D型1椎,E型1椎。通过X线片测量术前、术后及随访8个月时椎体前缘相对高、椎体成角,了解随访期间内固定失败及后凸畸形再发情况;通过CT测量术后椎体内空隙率,通过CT重建片了解术前中央终板骨折塌陷及术后复位情况。结果:所有患者随访8～15个月,平均12个月,伤椎前缘相对高度:术前40.1%,术后98.2%,术后8个月97.8%,术后较术前显著改善,而术后8个月与术后无显著性差异。伤椎椎体成角:术前18.3°,术后2.7°,术后8个月3.2°,术后较术前显著改善,而术后8个月与手术后无显著性差异;未发生内固定失败情况及后凸畸形再发;术后椎体内空隙率3.1%,中央终板骨折塌陷复位满意。结论:后路椎弓根螺钉固定结合自固化磷酸钙骨水泥椎体成形是治疗胸腰椎骨折较理想的方法,能有效防止内固定失败和椎体再发后凸畸形,同时终板撑开钳对中央终板具有良好的复位作用。Objective：To evaluate the clinical efficacy of posterior short segment pedicle screw fixation combined reduction of central end plate by end plate expand clamp and vertebroplasty with calcium phosphate cement for the treatment of thoracolumbar burst fractures. Methods：Thirty patients with thoracolumbar burst fractures were treated with posterior pedicle screw fixation combined reduction of central end plate by end plate expand clamp and vertebroplasty with calcium phosphate cement. There were 22 males and 8 females with an average of 47 years （range from 25 to 71 years）. Segment of fracture had 1 case in T11,5 in T12,14 in L1,8 in L2,2 in L3,1 in L4,1 in L5. According to Denis typing,4 cases were type A,25 type B,1 type C,1type D,1 type E. The relative anterior height of vertebral body and the vertebral angle were measured before and after operation and during the follow up period （8 months after operation） through X ray,the failure of internal fixation and recurrent kyphosis were evaluated during the follow up period. Vertebral intracorporeal gap was measured by CT images after operation and the central end plate fracture and reduction were observed by the reconstructed CT images （sagittal and coronary） before and after operation. Results：All patients were followed up from 8 to15 months with an average of 12 months. Relative anterior height of vertebral body and vertebral angle were well restored after operation,and there was no significant change between after operation and 8 months after operation. Preoperative,postoperative and 8 months after operation,relative anterior height of vertebral body respectively was 40.1%,98.2%,97.8%,vertebral angle respectively was 18.3°,2.7°,3.2°. No failure of internal fixation and recurrent kyphosis were found during the follow up period. The vertebral intracorporeal gap was about 3.1% and reduction of central endplate fracture was satisfactory. Conclusion：Posterior short segment pedicle screw fixation combined with vertebroplasty with calcium phosphate

关 键 词：脊柱骨折 骨折固定术 内 并发症 治疗结果 

分 类 号：R683.2[医药卫生—骨科学]