短节段椎弓根螺钉固定结合椎体增强术治疗胸腰椎爆裂性骨折  

Short-segment transpedicular fixation combined with augmentation vertebroplasty in treatment of thoracoluinbar burst fractures

作　　者：曾至立[1] 程黎明[1] 高生 钱列[1] 贾永伟[1] 于研[1] 王建杰[1] 曾诚[1] 高峰[1] 蒋荣辉[1] 

机构地区：[1] 同济大学附属同济医院脊柱外科,上海200065 [2]上海市嘉定区中心医院骨科

出　　处：《中华骨科杂志》2011年第9期927-931,共5页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金（30973034）;上海市科委科技攻关重点项目（08411952200）

摘　　要：目的探讨短节段椎弓根螺钉固定结合椎体增强术治疗胸腰椎爆裂性骨折的疗效。方法2006年11月至2009年9月采用短节段椎弓根螺钉固定结合自固化硫酸钙骨水泥椎体增强术治疗且有完整随访资料的胸腰椎爆裂性骨折患者37例，男21例，女16例；年龄39-60岁，平均47-3岁。术后评估伤椎前缘高度比、矢状面Cobb角、神经功能恢复、内固定失败率、疼痛视觉模拟评分及Oswestu功能障碍指数。结果随访14-37个月，平均19个月。无内固定失败。16例术前神经功能部分损害者12例完全恢复，无神经功能损害加重。自固化硫酸钙平均于术后3个月开始吸收，椎体骨折术后5个月内愈合。伤椎前缘高度比由术前55．40％±9．79％恢复至术后85．46％±6．56％，最终维持在82．35％±7．48％；矢状面Cobb角由术前22．45°±7．74°恢复至术后6．86°±5．27°，最终维持在9．66°±5．88°。末次随访时疼痛视觉模拟评分平均1．2，Oswestu功能障碍指数平均20．4。结论短节段椎弓根螺钉固定结合自固化硫酸钙骨水泥椎体增强术治疗胸腰椎爆裂性骨折安全、简便，能有效防止椎体高度丢失及进行性后凸畸形。Objective To evaluate the efficacy of short-segment transpedicular fixation combined with augmentation vertebroplasty in treatment of thoracolumbar burst fractures. Methods From November 2006 to September 2009, 37 patients with thoracolumbar burst fracture were admitted and received transpedicular fixation combined with calcium sulfate cement augmentation vertebroplasty, and the clinical data including fracture types, complications and following-up results were collected for analysis. The multi- method evaluation strategies involved the anterior vertebral body height, the sagittal Cobb＇s angle, the restoration of nervous function, internal fixation failure, visual analogue scale （VAS） and Oswestry disability index （ODI） were retrospective analyzed. Results All patients were followed up for average 19 months （range, 14-37）. There were no internal fixation failure, loss of reduction, neurological complications in all the patients. In 16 patients with partial neurologic deficits, 14 initially improved at the final follow-up, with no deterioration of neurologic functions. The mean time of calcium sulfate cement obvious absorption and union was 3 months and 5 months postoperatively, respectively. The anterior vertebral body height was 55.40% before surgery and 85.46% after surgery on average, ended up with 82.35%. The sagittal Cobb＇s angle was improved from 22.45° to 6.86°, ended up with 9.66° on average. The mean VAS and ODI at the final follow- up were respectively 1.2 and 20.4 on average. Conclusion Short-segment transpedicular fixation combined with augmentation vertebroplasty appears to be effective in achieving stable biomechanics with high security, which seems to be a feasible option in the management of thoracolumbar burst fractures.

关 键 词：胸椎 腰椎 骨折 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]