椎弓根钉复位固定结合注射型硫酸钙椎体成形术治疗胸腰椎骨折  

Pedicle screw reduction and fixation combined with calcium sulfate cement vertebroplasty in the treatment of thoracolumbar fractures

作　　者：魏力今 周业金 刘艺明 潘良春 李春 何高 

机构地区：[1]安徽医科大学第三附属医院脊柱外科,合肥230061

出　　处：《安徽医科大学学报》2011年第9期957-960,共4页Acta Universitatis Medicinalis Anhui

基　　金：安徽省卫生厅临床医学重点学科关键性技术应用项目(编号:05A045)

摘　　要：目的总结椎弓根钉复位固定结合注射型硫酸钙(CSC)椎体成形术治疗胸腰椎骨折的方法与疗效。方法对23例(25椎)胸腰椎骨折采用切开复位椎弓根钉固定,用特定注射器经伤椎椎弓根穿刺注入CSC进行椎体成形术治疗,影像学评估术前、术后及取钉12个月后矢状位指数(SI)及椎体前、后缘高度压缩率变化。结果平均每个椎体注入CSC 5.34 ml,6例术中发生椎旁渗漏,无椎管内渗漏,术后患者神经功能Frankel分级较术前提高1～2级(P<0.05)。术后8～12周影像学结果提示,硫酸钙在椎体内完全消失,被正常骨组织吸收。术后及取钉12个月后SI角及椎体前、后缘高度压缩率均较术前有明显改善(P<0.01),术后至取钉12个月后椎体前缘无明显丢失,但椎体后缘有少量丢失(P<0.05)。本组无椎弓根钉失败病例。结论椎弓根钉复位固定结合CSC椎体成形术治疗胸腰椎骨折,能使复位后的伤椎恢复其完整形态及椎体强度,提高胸腰椎骨折的临床疗效,其方法简便、安全,近期疗效满意。Objective To investigate the method and effect of pedicle screw reduction and fixation combined with calcium sulfate cement （CSC） vertebroplasty in the treatment of thoracolumbar fractures. Methods 23 cases （25 vertebrae） with thoracolumbar fractures were treated with pedicle screw sagittal index（SI） angle reduction and fixation combined with CSC vertebroplasty. According to imaging, we evaluated the change SI angle and compression ratio of vertebral body at the time of preopcration, postoperation and 12 months later. Results Each vertebra was injected with 5.34 ml CSC on average. 6 cases got paravertebral leakage. No vertebral canal leakage was found. Frankel grading of neural function was improved. CSC disappeared in 8 - 12 weeks and substituted by bone. In the postoperative and 12 months films, the SI angle, vertebral height were improved （P 〈 0. 01 ）. The anterior height did not lose in 12 months after instrument removal, while the posterior height got mild loss（P 〈 0. 05 ）. According to alanay system, there was no failure pedicle screw case. Conclusion Pedicle screw reduction and fixation combined with CSC vertebroplasty can optimally restore the configuration and strength of vertebral body in the treatment of thoracolumbar fractures, which the effect can be improved. This method is simple, safe and effective in short term.

关 键 词：胸椎 腰椎 脊柱骨折/外科学 椎体成形术 硫酸钙 

分 类 号：R683.1[医药卫生—骨科学] R687.3[医药卫生—外科学]