微创经椎弓根前柱植骨支柱块置入治疗胸腰椎压缩骨折

Minimally invasive bone graft in anterior column through pedicle for thoracolumbar vertebral compression fractures

中文关键词:  胸腰椎压缩骨折  支柱块  内固定  疗效

英文关键词:Thoracolumbar compression fracture  Pillar block  Internal fixation  Outcome

中文摘要:

  【摘要】 目的：探讨微创经椎弓根前柱植骨支柱块置入治疗胸腰椎压缩骨折的临床效果。方法：2009年5月至2010年4月，采用微创经椎弓根前柱植入骨粉、支柱块置入治疗胸腰椎压缩骨折患者21例，男12例，女9例，年龄48～76岁，平均59.7岁。均为单椎体压缩骨折，T11 2例，T12 5例，L1 9例，L2 4例，L3 1例。术前伤椎楔变角16.67°±1.70°，后凸Cobb角23.43°±1.73°，伤椎前缘高度（61.85±4.34）%，矢状面指数（伤椎前缘高度/伤椎后缘高度×100%，SI）（59.48±4.15）%。VAS评分8.3±1.0分。记录手术时间和失血量；术后1周、3个月、6个月及12个月摄X线片，观察伤椎楔变角、后凸Cobb角的矫正程度，伤椎前缘高度、SI恢复情况和支柱块位置，并行VAS评分评价疼痛改善情况。结果：21个椎体共用42枚椎体支柱块，手术均顺利完成手术，平均手术时间为51.2min，平均术中失血量26.4ml。术后CT检查11例患者椎弓根皮质有破裂，其中外侧皮质破裂10例，内侧皮质破裂1例，均无明显神经并发症。术后均获得随访，随访时间为15～26个月，平均21.3个月，术后各随访时间点伤椎楔变角、后凸Cobb角、伤椎前缘高度和SI、VAS评分均较术前明显改善（P＜0.05）。术后3个月椎弓根破裂皮质均自行愈合，末次随访时，伤椎前缘高度无明显丢失，椎体支柱块未发生移位或塌陷。结论：在严格掌握手术适应证的前提下，微创经椎弓根前柱植骨支柱块置入治疗胸腰椎压缩骨折具有手术时间短、出血少、椎体复位满意等优点，近期疗效满意。

英文摘要:

  【Abstract】 Objective：To study the clinical outcome of minimally invasive bone graft in anterior column through pedicle for thoracolumbar vertebral compression fractures.Method：From May 2009 to April 2010，21 patients undergoing bone graft in anterior column through pedicle ｆｏｒ thoracolumbar vertebral compression fractures were enrolled in this study.There were 12 males and 9 females with the average age of 59.7 years（range，48-76 years）.All patients had single vertebra involved，which included 2 T11，5 T12，9 L1，4 L2 and 1 L3.Preoperative evaluation included nature history，physical examination and imaging，which detailed as the wedge angle of 16.67°±1.70°，the Cobb angle of 23.43°±1.73°，the anterior height of the fracture vertebral body of （61.85±４.３４）%，the sagittal index（SI：the anterior height of the fracture vertebral body/the posterior height of the fracture vertebral body×100%） of（59.48±4.15）%．Ｔhe visual analogue scale（VAS） score was 8.3±1.0.The operative time and blood loss were recorded.The radiographs of 1 week，3 months，6 months and 12 months at follow-up were reviewed retrospectively，and the wedge angle of involved vertebra，kyphosis correction，the anterior vertebral height restoration，sagittal index（SI），and graft location as well as VAS score were reviewed.Result：All the patients underwent surgery successfully．Ｔhe average operation time was 51.2min， and blood loss was 26.4ml.Postoperative CT scan revealed breakout of pedicle cortex in 11 patients，with 10 laterally and 1 medially，however no neurological deficit wａｓ noted.All the patients were followed up for a mean of 21.3 months（range，15-26 months）.There were significant difference with respect to the wedge angle，kyphosis Cobb angle，SI，VAS score and anterior height of involved vertebral body between pre and post-operation（P＜0.05）.The ruptured pedicle cortex healed after 3 months.At final follow-up，no loss of correction and graft displacement were noted.Concluｓion：Minimally invasive bone graft in anterior column through pedicle for thoracolumbar vertebral compression fractures is of less surgical time，less blood loss and maintaining of correction, which is reliable for short term outcome.