中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (22): 4127-4130.doi: 10.3969/j.issn.1673-8225.2010.22.035

• 骨与关节临床实践 clinical practice of the bone and joint • 上一篇    下一篇

膨胀式椎弓根螺钉置入内固定治疗老年骨质疏松性胸腰椎骨折：同一机构1年16例18个月随访

肖伟平1，钟发明2，李  勇1，吕  劲1，柯桥宁1，汤敏予1   

  1. 1江西中医学院附属医院创伤骨科，江西省南昌市  330006；2 江西中医学院，江西省南昌市  330006
  • 出版日期:2010-05-28 发布日期:2010-05-28
  • 作者简介:肖伟平★，男， 1977年生，江西省新余市人，汉族，2005年江西中医学院毕业，硕士，主治医师，讲师，主要从事创伤研究。 jxxiaowp@yahoo.cn

Expansive pedicle screw placement fixation for the treatment of senile osteoporotic thoracolumbar vertebral fractures: 18-month follow-up data of 16 cases within one year in the same institution 

Xiao Wei-ping1, Zhong Fa-ming2, Li Yong1, Lü Jin1, Ke Qiao-ning1, Tang Min-yu1   

  1. 1 Department of Orthopedic Trauma, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang   330006, Jiangxi Province, China；2 Jiangxi University of Traditional Chinese Medicine, Nanchang   330006, Jiangxi Province, China
  • Online:2010-05-28 Published:2010-05-28
  • About author:Xiao Wei-ping★, Master, Attending physician, Lecturer, Department of Orthopedic Trauma, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang 330006, Jiangxi Province, China jxxiaowp@yahoo.cn

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摘要：

背景：对于老年骨质疏松性胸腰椎骨折患者，普通椎弓根螺钉的把持力不够或术后承载负荷过大容易造成椎弓根螺钉的松动或脱出，从而导致内固定失效或假关节形成。
目的：观察膨胀式椎弓根螺钉置入内固定治疗老年骨质疏松性胸腰椎骨折的效果。
方法：选择骨质疏松性胸腰椎压缩骨折患者16例，男6例，女10例，年龄73.6（59~83)岁；单椎体压缩骨折11例，两椎体骨折5例(无跳跃式骨折)，其中爆裂骨折4例。累及椎体：T 12 7个，L1 10个，L2 3个，L4 1个；术前脊髓和神经根受压4例。均采用膨胀式椎弓根螺钉置入内固定治疗，对于有脊髓神经压迫椎管占位> 50%者，行椎板减压及后外侧植骨。安装好固定棒，依靠固定棒将内栓挤入外螺钉的中空内，安装预弯好的棒进行撑开，恢复椎体高度使骨折复位，爆裂骨折行自体髂骨作横突及关节突间植骨。
结果与结论：16例术后伤口全部愈合，无伤口感染，无脑脊液漏，无术中、术后死亡，术后X射线及CT检查见骨折已复位，脊髓压迫解除。经过6~24个月随访，X射线片显示植骨均已融合，无内固定物松动、断裂，无假关节形成，无明显腰背部疼痛；术后椎体前缘、椎体后缘高度较术前明显提高(P ≤ 0.01)，后凸畸形纠正范围较术前恢复11°~27°。说明膨胀式椎弓根螺钉置入内固定在不增加螺钉长度和在椎弓根内直径，降低椎弓根处骨折风险的情况下，提供了较普通螺钉更加可靠的固定强度，是老年骨质疏松性胸腰椎骨折理想的内固定器。　

关键词: 脊柱损伤, 内固定器, 椎弓根螺钉, 置入内固定, 硬组织植入物

Abstract:

BACKGROUND: For the elderly osteoporotic patients with osteoporotic thoracolumbar vertebral fractures, the inadequate ordinary power of pedicle screws in control or excessive load after the operation results in the loosening or prolapse of pedicle screws, leading to fixation failure or pseudoarthrosis.
OBJECTIVE: To observe effects of expansive pedicle screw (expansive pedicle screw, EPS) implantation for internal fixation of thoracolumbar osteoporotic fracture in the aged.
METHODS: A total of 16 patients with osteoporotic thoracolumbar vertebral compression fractures, 6 males and 10 females, aged 73.6 (59-83) years. There were single vertebral compression fractures in 11 cases, two vertebral fractures in 5 cases (non-leap fractures), of which there was burst fracture in 4 cases. There were T12 in 7 cases, L1 in 10 cases, L2 in 3 cases, and L4 in 1 case; preoperative spinal cord and nerve root compression in 4 cases. Expansive pedicle screw fixation placement was adopted, for a spinal cord compression spinal space-occupying more than 50%, laminectomy was performed. Fixed rods were installed, relying on a fixed bar to squeeze into the outer screw inside the hollow bolt, a pre-bend good stick was installed to restore vertebral height so that fractures reduced, burst fractures were subjected to transverse autologous iliac bone and articular process grafting.
RESULTS AND CONCLUSION: The wound of postoperative 16 patients healed without wound infection, cerebrospinal fluid leakage, or postoperative death. Postoperative X-ray and CT examination showed that the fracture had been reduced, and spinal cord compression disappeared. After 6 to 24 months follow-up, X-ray films showed fusion, without internal fixation loosening, fracture, false joint formation, or significant back pain. Postoperative vertebral anterior and posterior edge heights were significantly increased compared with preoperative heights (P≤0.01). Kyphosis range corrected was 11°-27°. Under the circumstances of no increase in screw length and diameter as well as decreased risk for vertebral pedicle fracture, expansive pedicle screw placement provides more reliable strength compared with the ordinary screw fixation and is an ideal fixation device for osteoporotic thoracolumbar vertebral fractures in aged patients.

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