胸腰椎骨折椎弓钉固定伤椎体内植骨

Pedicle screw fixation combined with bone grafting into the affected vertebral body for thoracolumbar fractures

摘要:

[目的] 评价椎弓钉固定骨水泥穿刺锥伤椎椎体内植骨治疗胸腰椎骨折的临床效果。[方法] 回顾性分析2018 年1月—2022 年6 月的采用上述方法治疗的55 例胸腰椎骨折患者的临床资料，椎弓钉固定复位后，应用骨水泥穿刺锥行伤椎“空腔”靶向穿刺，向椎体内植骨。评价患者的临床与影像资料。[结果] 55 例患者均完成手术，术后所有患者均未出现神经损伤等并发症，术中透视见椎弓根钉位置满意，手术时间（82.6±13.8） min、出血量（51.5±15.7） ml，随访（18.8±8.7） 个月。与术前相比，术后3 d 和末次随访时VAS 评分显著下降[(7.2±1.3), (2.0±1.3), (1.0±1.3), P＜0.001]。影像方面，与术前相比，术后3 d和末次随访时伤椎压缩率[(42.6±9.6)%, (2.1±1.5)%, (3.2±0.9)%, P＜0.001] 和局部后凸Cobb 角[(24.1±5.5)°, (3.0±2.2)°, (3.2±2.1)°, P＜0.001] 均显著减少。至末次随访时，伤椎内植骨均达骨性愈合，伤椎椎体高度无明显丢失，无内固定装置的松动断裂。[结论] 椎弓钉固定骨水泥穿刺锥伤椎椎体内植骨治疗胸腰椎骨折，可获得稳定的骨折复位固定，避免复位后高度丢失。

Abstract:

[Objective] To evaluate the clinical outcomes of pedicle screw fixation combined with bone grafting into the affected verte-bral body for thoracolumbar fractures. [Methods] A retrospective study was conducted on 55 patients who were treated with the above surgi-cal methods for thoracolumbar fractures from January 2018 to June 2022. After fixation and reduction with pedicle screw-rod system, target-ed puncture aimed the "cavity" of injured vertebrae was performed with bone cement puncture needle, and bone graft was implanted intothe vertebral body through the needle. Clinical and imaging data of the patients were evaluated. [Results] All the 55 patients were operatedon smoothly, without complications, such as nerve injury, while with satisfactory position of pedicle screw placed revealed by intraoperativefluoroscopy, operation time of (82.6±13.8) min and intraoperation blood loss of (51.5±15.7) ml. All the patients were followed up for (18.8±8.7) months on an average. Compared with that preoperatively, the VAS score significantly decreased 3 days postoperatively and at the lat-est follow-up [(7.2±1.3), (2.0±1.3), (1.0±1.3), P＜0.001]. Radiographically, the vertebral body compression ratio [(42.6±9.6)%, (2.1±1.5)%,(3.2±0.9)%, P＜0.001] and local kyphotic Cobb angle [(24.1±5.5)°, (3.0±2.2)°, (3.2±2.1)°, P＜0.001] significantly reduced. At the last followup,all the injured vertebral body got bony healing without obvious loss of vertebral height, and no loosening or fracture of internal fixationdevices. [Conclusion] The pedicle screw fixation combined with bone grafting into the affected vertebral body for thoracolumbar fracturesdoes obtain more stable fracture reduction and fixation to avoid vertebral height loss.