微创椎弓根钉内固定联合磷酸钙骨水泥椎体成形术治疗胸腰椎爆裂性骨折

摘要

目的：评估微创椎弓根钉内固定（微小切口非空心椎弓根钉技术）联合磷酸钙骨水泥经皮穿刺椎体成形术（percutaneous vertebroplasty ，PVP）治疗胸腰椎爆裂性骨折的疗性和安全性。方法：采用微创椎弓根钉内固定联合磷酸钙骨水泥 PVP术治疗23例单节段胸腰椎新鲜爆裂性骨折且无神经症状的患者，伤椎位于 T11～L2，均属A3型骨折。记录手术时间、术中出血量、骨水泥注射量和住院天数。记录术前及术后即刻、1个月、2个月、3个月、6个月、1年、2年的腰背痛评分，计算并比较各时点的椎体高度压缩率、恢复率、椎体后凸角、椎体后凸矫正率。结果：磷酸钙骨水泥平均注射量为4．9（3．8～6．4）mL，平均手术时间92（75～120） min ，平均出血量52（40～75） mL ，平均住院5．6（4～7） d ，术后平均随访26（24～29）个月。VAS评分由术前的（8．8±1．2）分下降至术后即刻的（1．8±0．6）分及术后2年的（0．4±0．5）分，差异均有显著统计学意义（P＜0．001）。高度压缩率由术前的（50．4±7．2）％显著下降至术后即刻的（6．2±1．5）％及术后2年的（6．9±1．4）％，差异均有显著统计学意义（P＜0．001）。后凸角由术前的（22．6±1．8）°下降至术后即刻的（3．2±1．7）°及术后2年的（5．1±1．5）°，差异均有显著统计学意义（ P＜0．001）。随访过程中术后高度恢复率、后凸矫正率无明显减小；未出现螺钉松动、断钉或断棒。结论：微创椎弓根钉内固定联合磷酸钙骨水泥PV P术是治疗胸腰椎爆裂性骨折的安全、有效的方法。%Objective:To evaluate the efficacy and safety of minimally invasive pedicle screw fixation combined with percutaneous vertebroplasty(PVP) with calcium phosphate bone cement in the treatment of acute thoracolumbar burst fracture . Methods:Twenty‐three patients ,who suffered from single fresh thoracolumbar burst fracture without neurologic deficits and were classified as A3 fracture located between T11~L2 ,underwent the procedure of minimally invasive pedicle screw fixation combined with PVP with calcium phosphate bone cement .Duration of operation and blood loss ,injected volume of bone cement and length of stay ,were recorded .Lumbago and backache scores assessed by visual analogue scale (VAS) were recorded before surgery ,immediately after surgery ,as well as 1 month ,2 months ,3 months ,6 months ,1 year and 2 years after surgery . Vertebral compression rate and restoring rate ,Cobb angle and correction rate of vertebral kyphosis ,were measured at each time point and compared among the time points .Results:The average injected volume of calcium phosphate bone cement was 4 .9(3 .8~6 .4)mL .The mean duration of operation was 92(75~120)min .The average blood loss was 52(40~75)mL .The mean length of stay was 5 .6(4~ 7) d and the average follow‐up period was 26 months (24 ~ 29) .The VAS significantly decreased from 8 .8 ± 1 .2 before surgery to 1 .8 ± 0 .6 immediately after surgery and 0 .4 ± 0 .5 at 2 years after surgery ,and the differences were statistically significant(P< 0 .001) .The compression rate of vertebral body height decreased from(50 .4 ± 7 .2)% before surgery to (6 .2 ± 1 .5)% immediately after surgery and(6 .9 ± 1 .4)% at 2 years after surgery ,and the differences were statistically significant(P<0 .001) .The Cobb angle decreased from (22 .6 ± 1 .8)° before surgery to (3 .2 ± 1 .7)° immediately after surgery and (5 .1 ± 1 .5)° at 2 years after surgery ,and the differences were statistically significant(P<0 .001) .No significant decrease in both kyphosis correction and vertebral body height restoration was observed during the follow‐up .There was no loosen screw or broken screw .Conclusions:Minimally invasive pedicle screw fixation combined with PVP with calcium phosphate bone cement is a safe and efficacious method for the treatment of thoracolumbar vertebral burst fracture .