脊柱外固定器下MED技术联合椎体成形治疗胸腰椎爆裂性骨折  

The clinical application of external fixation assisted MED technique in the treatment of thora-columbar and lumbar burst fracture

作　　者：胡安文[1] 罗光平[1] 肖业生[1] 杨长远[1] 袁泉 向超[1] 刘洪[1] 朱钧[1] 

机构地区：[1]南华大学附属怀化市第一人民医院骨外科,怀化418000

出　　处：《中国矫形外科杂志》2011年第12期982-986,共5页Orthopedic Journal of China

摘　　要：[目的]探讨在脊柱外固定器下用椎间盘镜行椎管减压联合椎体成形术(PVP)治疗胸腰椎爆裂性骨折的临床疗效。[方法]2006年6月～2009年6月应用新型脊柱外固定器对伤椎行体外固定复位?椎间盘镜行椎管微创减压,联合经皮椎体成形术(PVP)用骨水泥固化伤椎或经椎弓根行椎体内植骨治疗36例胸腰椎爆裂性骨折,观察伤椎Cobb角?伤椎前缘高度比?椎管狭窄率的变化,随访6个月按照Frankel脊髓损伤分级标准评定患者神经功能恢复情况。[结果]所有患者均安全完成手术,无脊髓和神经根损伤发生,16例行PVP的患者拆除外固定的时间平均为(3.38±0.75)周,20例骨融合拆除外固定的时间平均在(10.5±2.27)周,术后随访6～41个月,平均20个月,5例出现外固定器钉孔感染,2例出现螺钉松动,均经相应处理或拆除外固定后治愈,无其他严重并发症发生。伤椎Cobb角由术前的平均30.7°±6.30°恢复至术后的平均4.62°±3.19°(P<0.01);伤椎椎体前缘高度比平均恢复至94.6%±6.45%,较术前的58.66%±6.06%明显改善(P<0.01);椎管狭窄率由术前的35.20%±8.73%改善至术后的平均7.65%±3.80%(P<0.01);神经功能Frankel分级术后6个月时平均提高1.27±0.44级。[结论]脊柱外固定器结合椎间盘镜减压和椎体成形治疗胸腰椎爆裂性骨折能实现对胸腰椎爆裂性骨折的体外复位固定和微创减压,减少手术创伤和伤椎非椎间融合固定,是治疗胸腰椎爆裂性骨折的疗效较好的微创手段。[ Objective] To study the feasibility and clinical outcomes of a new pereutanous external transpedicle fixation （PETF） assisted MED techqinque for surgical treatment of thoralumbar and lumbar burst fracture. [ Method] From June 2006 to June 2007,36 patients of thoracolumbar or lumbar burst fracture with spinal stenosis were analyzed retrospectively, They were treated by PETF technique combined with vertebral canna1 decompression under MED system and PVP with polymethylnlethacry- late（PMMA） or calcium phosphate cement （CPC）or auto bone graft. The changes of Cobb angle and anterior height of the verte- bral body between preoperative and post-operative X-ray examinations and the rate of spinal stenosis were measured. The recovery of nerve function was evaluated by Frankel grade at 6-month follow-up. [ Result] All patients underwent surgery safely and no severe cmnplications occurred. Postoperatively,the average time for removal of PETF was 3.38 ± 0.75 weeks in 16 patients undergoing PVP and 10.50 ±2.27 weeks in 20 patients undergoing auto bone graft. All patients were followed up for an average of 20 months （range,6 -41 months）. The clinical effect was satisfying except 5 suffering from bolt-hole infection and 2 with screw loosening. The postoperative Cobb angle of injury centrum was 4.62° ± 3.19°, and the preoperative kyphotic angle was 30, 7° ±6.30° （P 〈 0.01 ）. The rate of height of anterior border of injury eentrum increased obviously from 58.66% ±6.06% betore operation to 94.60% ± 6.45% after operation（ P 〈 0.01 ）. The rate of spinal stenosis decreased significantly from 35.20% ± 8.73% before operation to 7.65% ±3.80% after operation（ P 〈 0.01 ）. According to Frankel classification,the average recovery of the paralysis raised by 1.27 ±0.44 grade at 6-month follow up. [ Conclusion] The PETF assisted MED techqinque and PVP can provide mini-invasion reduction and decompression and non-fusion fixation for the fractured vertebral body. It is an effective mini-trauma met

关 键 词：脊柱外固定器 椎间盘镜 微创 胸腰椎爆裂性骨折 非融合固定 

分 类 号：R687.3[医药卫生—骨科学]