经皮椎弓根螺钉内固定联合伤椎磷酸钙骨水泥填充治疗胸腰椎爆裂骨折的临床疗效及迟发性渗漏原因分析  

Analysis of the clinical effect of percutaneous pedicle screw fixation combined with calcium phosphate cement filling in the treatment of thoracolumbar burst fracture and the cause of delayed leakage

作　　者：梅国龙[1] 万趸[1] 熊小明[1] 石华刚[1] 邓轩赓[1] 侯伟[1] MEI Guo-long;WAN Dun;XIONG Xiao-ming;SHI Hua-gang;DENG Xuan-geng;HOU Wei(Department of Spine Surgery,Sichuan Provincial Orthopedics Hospital,Chengdu 610041,China)

机构地区：[1]四川省骨科医院脊柱科,成都610041

出　　处：《中国医学前沿杂志（电子版）》2018年第5期74-77,共4页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的探讨经皮椎弓根螺钉内固定联合伤椎磷酸钙骨水泥(calcium phosphate cement,CPC)填充治疗胸腰椎爆裂骨折的临床疗效,并分析CPC填充治疗导致迟发性渗漏的可能原因。方法选取2013年1月至2015年1月于本院接受经皮椎弓根螺钉内固定联合伤椎CPC填充治疗的无脊髓、神经功能损害的胸腰椎爆裂骨折患者21例为研究对象。比较患者术前、术后3天及术后6个月伤椎前缘高度压缩率、Cobb角、视觉模拟评分法(visual analogue score,VAS)评分及Oswestry功能障碍指数(Oswestry dability index,ODI)评分。探讨该治疗方式的临床效果,总结并分析CPC导致迟发性渗漏的可能原因。结果所有患者术后疼痛均明显缓解,无脊髓、神经损害表现,且均进行6个月的随访。20例患者术后X线片及CT均显示CPC填充良好,4例患者出现椎旁渗漏,无一例椎管内渗漏,仅1例患者发生迟发性椎旁渗漏。术后3天,患者Cobb角、ODI评分、伤椎前缘高度压缩率及VAS评分均显著低于术前(P<0.05)。术后6个月与术后3天,患者Cobb角、ODI评分、伤椎前缘高度压缩率及VAS评分比较均无显著差异(P>0.05)。结论经皮椎弓根螺钉内固定联合伤椎CPC填充治疗胸腰椎爆裂骨折的手术成功率高,能够显著改善患者术后疼痛和功能恢复,对胸腰椎爆裂骨折的治疗意义重大。Objective To explore the clinical effect of percutaneous pedicle screw fixation combined with calcium phosphate cement(CPC)filling in the treatment of thoracolumbar burst fracture,and to analyze the possible causes of delayed leakage caused by CPC filling.Method 21 patients with thoracolumbar burst fracture without nerve function damage treated by percutaneous pedicle screw fixation combined with CPC filling from January 2013 to January 2015 in our hospital were chosen as the research objects.The anterior height compressibility of vertebral body,Cobb angle,visual analogue score(VAS)and Oswestry dysfunction index(ODI)scores were compared before operation,3 days and 6 months after operation.The clinical effect of the treatment were explored,and the possible causes of delayed leakage caused by CPC filling wene analyzed and summarized.Result All patients had obvious relief of pain after operation,no spinal cord or nerve damage,and all patients were followed up for 6 months.20 cases of patients postoperative X-ray and CT showed that CPC were well filled,4 patients had paravertebral leakage,no intraspinal leakage,and only 1 patient had delayed leakage.3 days after operation,the patients'Cobb angle,ODI scores,anterior height compressibility of vertebral body and VAS scores were significantly lower than those before operation(P<0.05).There were no significant differences in Cobb angle,ODI scores,anterior height compressibility of vertebral body and VAS scores between 6 months and 3 days after operation.Conclusion Percu taneous pedicle screw fixation combined with CPC filling in the treatment of thoracolumbar burst fracture has a high success rate,which can significantly improve postoperative pain and functional recovery,which is of great significance for the treatment of thorac olumbar burst fractures.

关 键 词：胸腰椎爆裂骨折 磷酸钙骨水泥 经皮椎弓根螺钉内固定 迟发性渗漏 

分 类 号：R687.3[医药卫生—骨科学]