Sun Guan-Rong, Han Lei
Zhongguo Gu Shang. 2014 Feb;27(2):97-100.
To evaluate the clinical effects of short-segment transpedicular fixation and vertebroplasty via paraspinal intermuscular approach in treating thoracolumbar fractures.
From January 2009 to January 2012,18 patients with thoracolumbar fractures without neurological symptoms were treated with short-segment transpedicular fixation and vertebroplasty via paraspinal intermuscular approach. There were 11 males and 7 females, aged from 52 to 76 years old with an average of 62.2 years. The duration from injuries to surgery ranged from 8 h to 7 d with an average of 4.2 d. According to the Denis fracture classification, 12 cases got compression fractures and 6 cases got burst fractures.
6 vertebra with T12, 9 with L1, 6 with L2, and 3 with L3. Anterior vertebral body height, the sagittal Cobb angle, the sagittal index (SI), condition of internal fixation failure and recurrent kyphosis were observed.
All patients were followed up for 12-28 months with an average of 16.5 months. Operation time was from 80 to 130 min with a mean of 95 min and bleeding volume during operation ranged from 100 to 180 ml with a mean of 145 ml. Anterior vertebral body height ratios preoperation, 3 days after operation and final follow-up was 54.3 +/- 2.8, 90.9 +/- 1.5, 88.6 +/- 1.7, respectively; sagittal Cobb angle was (27.8 +/- 2.5) degrees, (5.3 +/- 0.8) degrees, (6.3 +/- 1.4) degrees, respectively; sagittal index was 52.3 +/- 3.8, 89.2 +/- 5.2, 86.4 +/- 4.5, respectively. Data obtained 3 days after operation obviously improved than preoperation, and there was no statistically significant difference between 3 days after operation and last follow-up. No internal fixation failure, neurological complications and recurrent kyphosis were found.
Treatment of thoracolumbar fractures with short-segment transpediclar screw fixation and vertebroplasty via paraspinal intermuscular approach can retain the posterior ligament complex and restore the mechanical strength of the anterocentral column,which proved an ideal method for preventing the failure of internal fixation and reduction of post-traumatic segmental kyphosis.
评估经椎旁肌间隙入路短节段椎弓根内固定联合椎体成形术治疗胸腰椎骨折的临床疗效。
2009年1月至2012年1月，对18例无神经症状的胸腰椎骨折患者采用经椎旁肌间隙入路短节段椎弓根内固定联合椎体成形术治疗。其中男11例，女7例，年龄52～76岁，平均62.2岁。受伤至手术时间8 h至7 d，平均4.2 d。按Denis骨折分类，压缩骨折12例，爆裂骨折6例。
T12椎体6例，L1椎体9例，L2椎体6例，L3椎体3例。观察椎体前缘高度、矢状面Cobb角、矢状指数（SI）、内固定失败情况及后凸畸形复发情况。
所有患者均获随访，时间12～28个月，平均16.5个月。手术时间80～130 min，平均95 min；术中出血量100～180 ml，平均145 ml。术前、术后3天及末次随访时椎体前缘高度比值分别为54.3±2.8、90.9±1.5、88.6±1.7；矢状面Cobb角分别为（27.8±2.5）°、（5.3±0.8）°、（6.3±1.4）°；矢状指数分别为52.3±3.8、89.2±5.2、86.4±4.5。术后3天各项数据较术前明显改善，术后3天与末次随访比较差异无统计学意义。未发现内固定失败、神经并发症及后凸畸形复发。
经椎旁肌间隙入路短节段椎弓根螺钉内固定联合椎体成形术治疗胸腰椎骨折可保留后韧带复合体，恢复前中柱力学强度，是预防内固定失败及减少创伤后节段性后凸畸形较为理想的方法。
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