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小儿椎体压缩性骨折经皮椎弓根外椎体成形术联合可膨胀椎体内植入物——技术说明

Percutaneous extrapedicular vertebroplasty with expandable intravertebral implant in compression vertebral body fracture in pediatric patient-technical note.

作者信息

Polis Bartosz, Krawczyk Jacek, Polis Lech, Nowosławska Emilia

机构信息

Polish Mother's Memorial Hospital Research Institute, Rzgowska Street 281/289, 93-338, Łódź, Poland.

出版信息

Childs Nerv Syst. 2016 Nov;32(11):2225-2231. doi: 10.1007/s00381-016-3250-8. Epub 2016 Sep 26.

DOI:10.1007/s00381-016-3250-8
PMID:27669697
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5086345/
Abstract

PURPOSE

The aim of the article is to present the new extrapedicular percutaneous technique for posttraumatic vertebral column fracture.

METHODS

A 15-year-old boy needed a surgical Th8 posttraumatic vertebral body (VB) compressive fracture reduction due to insufficient conservative treatment and consistent severe clinical symptoms. After 6 months of external Jevett long-roll brace stabilization, progressive sagittal balance disturbance of thoracic kyphosis was measured and persistent clinical symptoms were observed. It was decided to present a surgical technique method allowing to attempt to reduce VB fracture, rebalance the vertebral column (VC) without any motion limitation, and decrease clinical symptoms. The procedure was performed percutaneously from extrapedicular approach with intravertebral implant (Spine Jack®-Vexim™) and cement (Interface®-Vexim™) under fluoroscopic imaging (Ziehm™ 8000®).

RESULTS

The whole procedure was uneventful. Now, the child is free from clinical symptoms and the partial reduction of VB fracture was achieved. The patient has been followed for 3 months. In the control CT scans, the VB fracture reduction is stable and no progression of thoracic kyphosis angle is observed. Furthermore since the surgical procedure, the patient is clinical symptom free.

CONCLUSION

The extrapedicular percutaneus technique of VB fracture reduction with intravertebral fixation allowed to partially reduce the VB compressive fracture, rebalance the VC without any motion limitation, avoid external long-roll brace, and eliminate clinical symptoms. The procedure is minimally invasive, fast, and clinically effective. However, the technique should be restricted only to carefully selected clinical cases.

摘要

目的

本文旨在介绍创伤后脊柱骨折的新型经椎弓根外 percutaneous 技术。

方法

一名 15 岁男孩因保守治疗不足且临床症状持续严重，需要对 Th8 创伤后椎体（VB）压缩性骨折进行手术复位。在使用外部 Jevett 长滚支具稳定 6 个月后，测量了胸椎后凸的进行性矢状面平衡紊乱，并观察到持续的临床症状。决定提出一种手术技术方法，试图减少 VB 骨折，在不限制任何活动的情况下重新平衡脊柱（VC），并减轻临床症状。该手术在透视成像（Ziehm™8000®）下经椎弓根外入路经皮进行，使用椎体内植入物（Spine Jack®-Vexim™）和骨水泥（Interface®-Vexim™）。

结果

整个手术过程顺利。现在，患儿已无临床症状，VB 骨折部分复位。对患者进行了 3 个月的随访。在对照 CT 扫描中，VB 骨折复位稳定，未观察到胸椎后凸角度进展。此外，自手术以来，患者无临床症状。

结论

经椎弓根外 percutaneous 技术结合椎体内固定进行 VB 骨折复位，能够部分减少 VB 压缩性骨折，在不限制任何活动的情况下重新平衡 VC，避免使用外部长滚支具，并消除临床症状。该手术微创、快速且临床有效。然而，该技术应仅局限于精心挑选的临床病例。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1944/5086345/7f1945abddfb/381_2016_3250_Fig15_HTML.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1944/5086345/34c710ec1c76/381_2016_3250_Fig11_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1944/5086345/793305158060/381_2016_3250_Fig12_HTML.jpg
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