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目的:椎体撬拨胎儿骨植骨成形加椎弓根螺钉固定治疗胸腰椎爆裂性骨折,预防术后形成“空心椎引起的钉松动、断钉及伤椎再塌陷、后凸畸形等并发症。方法:收治胸腰椎爆裂性骨折患者18例,行椎弓根螺钉内固定后,用神经根探子撬拨压缩下陷的伤椎上终板和前中柱,使之复位,经伤椎通过椎弓根胎儿骨植骨成形。结果:术后随访6～18月,全部获得骨折愈合(100%)。脊柱后凸cobb角度术前平均22.5度(n =18)矫正至术后平均4.7度(n=18)。随访角度5.3度;椎体前缘高度压缩比由术前平均46%恢复至术后97%,随访是94%;伤椎椎管内矢状径术前7.5mm,术后16.9mm,随访矢状径16.7mm,无明显狭窄。无内固定松动、断裂或弯曲。结论:椎体撬拨胎儿骨植骨成形加椎弓根螺钉固定治疗胸腰椎爆裂性骨折,手术安全性高,经植骨均获得骨性愈合,恢复了伤椎的强度和刚度,减少了内固定的应力,防止后凸畸形,降低并发症出现。
Objective: To pry the vertebral bone graft with pedicle screw fixation and pedicle screw fixation in the treatment of thoracolumbar burst fractures, to prevent the formation of postoperative ”hollow spine caused by nail loose, broken nail and injured vertebral collapse, kyphosis and other complications Methods: 18 patients with thoracolumbar burst fracture were treated with pedicle screw fixation, the nerve root prick was poked to compress the sagging endplate and the anterior central column, All patients were followed up for 6 ~ 18 months (100%). The cobb angle of the kyphosis was averagely corrected to 22.5 degrees (n = 18) and averaged 4.7 degrees after the operation (n = 18) .The follow-up angle of 5.3 degrees; vertebral anterior height compression ratio from 46% before surgery to restore the postoperative 97%, followed up was 94%; intraspinal spinal sagittal 7.5mm before surgery After 16.9mm, the sagittal diameter of follow-up was 16.7mm, no obvious stenosis, no loosening, rupture or bending of internal fixation.Conclusion: The vertebral body was implanted with pedicle screw fixation and pedicle screw fixation for the treatment of thoracolumbar burst fractures. High, bone graft were obtained by bone healing, restoration of vertebral strength and stiffness, reducing the stress of internal fixation to prevent kyphosis And reduce complications.