Department of Orthopaedic Surgery, The University of Texas Health Science Center at Houston, Suite 110, Bellaire, TX 77401, USA.
J Bone Joint Surg Am. 2010 Mar;92 Suppl 1 Pt 1:67-76. doi: 10.2106/JBJS.I.01236.
The treatment of unstable thoracolumbar burst fractures with short-segment posterior spinal instrumentation without anterior column reconstruction is associated with a high rate of screw breakage and progressive loss of reduction. The purpose of the present study was to evaluate the functional, neurologic, and radiographic results following transpedicular, balloon-assisted fracture reduction with anterior column reconstruction with use of calcium phosphate bone cement combined with short-segment posterior instrumentation and a laminectomy.
A consecutive series of thirty-eight patients with an unstable thoracolumbar burst fracture with or without neurologic deficit were managed with transpedicular, balloon-assisted fracture reduction, calcium phosphate bone cement reconstruction, and short-segment spinal instrumentation from 2002 to 2005. Twenty-eight of the thirty-eight patients were followed for a minimum of two years. Demographic data, neurologic function, segmental kyphosis, the fracture severity score, canal compromise, the Short Form-36 score, the Oswestry Disability Index score, and treatment-related complications were evaluated prospectively.
All thirteen patients with incomplete neurologic deficits had improvement by at least one Frankel grade. The mean kyphotic angulation improved from 17 degrees preoperatively to 7 degrees at the time of the latest follow-up, and the loss of vertebral body height improved from a mean of 42% preoperatively to 14% at the time of the latest follow-up. Screw breakage occurred in two patients, and pseudarthrosis occurred in one patient.
The present study demonstrates that excellent reduction of unstable thoracolumbar burst fractures with and without associated neurologic deficits can be maintained with use of short-segment instrumentation and a transpedicular balloon-assisted reduction combined with anterior column reconstruction with calcium phosphate bone cement performed through a single posterior incision. The resultant circumferential stabilization combined with a decompressive laminectomy led to maintained or improved neurologic function in all patients with neurologic deficits, with a low rate of instrumentation failure and loss of correction.
对于不稳定型胸腰椎爆裂骨折，不进行前柱重建而采用短节段后路脊柱内固定治疗，会导致螺钉断裂和复位丢失进行性加重。本研究的目的在于评估经皮椎弓根球囊辅助复位结合磷酸钙骨水泥重建前柱，同时联合短节段后路内固定和椎板切除术治疗不稳定型胸腰椎爆裂骨折的功能、神经功能和影像学结果。
2002 年至 2005 年，我们采用经皮椎弓根球囊辅助复位、磷酸钙骨水泥重建、短节段脊柱内固定治疗伴或不伴神经功能缺损的不稳定型胸腰椎爆裂骨折患者 38 例，其中 28 例获得至少 2 年随访。前瞻性评估患者的一般资料、神经功能、节段后凸角度、骨折严重程度评分、椎管侵占程度、SF-36 评分、Oswestry 功能障碍指数评分和治疗相关并发症。
13 例不完全性神经功能缺损患者的神经功能均至少提高 1 个 Frankel 分级。术前平均后凸角度为 17°，末次随访时为 7°，术后椎体高度丢失从术前的平均 42%改善至 14%。2 例患者出现螺钉断裂，1 例患者出现假关节。
本研究表明，通过单一后路切口，采用短节段内固定结合经皮椎弓根球囊辅助复位联合磷酸钙骨水泥重建前柱，可以实现并维持伴或不伴神经功能缺损的不稳定型胸腰椎爆裂骨折的良好复位。后路复位结合减压性椎板切除术可维持或改善所有伴神经功能缺损患者的神经功能，内固定失败和矫正丢失的发生率较低。
