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目的 探讨新型经皮自撑开复位螺钉系统治疗椎体高度丢失严重胸腰椎骨折的安全性及有效性.方法 自2014年3月至2015年6月,38例椎体高度丢失＞50％的胸腰椎骨折患者采用新型经皮自撑开复位螺钉治疗.该螺钉系统为单平面螺钉(自带0°、3°、6°、9°的复位角度),术中在顶帽锁紧过程中自动复位骨折椎体.所有患者均为单椎体骨折,手术均采用经皮螺钉固定复位技术,应用2组螺钉固定伤椎邻近上、下位椎体并对伤椎进行复位,术中均未行植骨融合.主要观察指标为患者术前、术后、术后6个月及末次随访时的椎体指数、伤椎前缘高度、伤椎成角、后凸Cobb角、疼痛视觉模拟评分(visual analogue scale,VAS)及Oswestry功能障碍指数(oswestry disability index,ODI),采用t检验进行统计学分析.结果 38例患者手术均获成功,共置入152枚经皮椎弓根螺钉,术后CT评估置钉准确率为98.7％.手术时间平均为(90.7±21.9) min;术中出血量平均为(89.2±31.9) ml.椎体指数由术前0.38±0.07改善至术后0.93±0.03,末次随访时为0.92±0.03;伤椎前缘高度由术前0.38±0.06改善至术后0.95±0.02,末次随访时为0.94±0.02;伤椎成角由术前25.45°±4.54°改善至术后3.71°±1.35°,末次随访时为3.89°±1.31°;后凸Cobb角由术前18.66°±8.57°改善至术后5.84°±6.80°,末次随访时为6.05°±7.00°;VAS评分由术前(7.76±1.02)分改善至术后(4.29±1.16)分,末次随访时为(1.71 ±0.65)分;ODI由术前44.58％±2.33％改善至术后24.37％± 1.88％,末次随访时为5.95％±2.67％.各观察指标术后、末次随访时与术前比较,差异均有统计学意义(P＜0.05).结论 新型经皮自撑开复位螺钉系统治疗椎体高度丢失严重的胸腰椎骨折,可取得了令人满意的骨折复位及后凸畸形矫正效果.

Objective To explore the safety and effectiveness of a novel percutaneous self-expanding forceful reduction screw system in the treatment of thoracolumbar fracture with severe vertebral height loss.Methods Thirty-eight patients of thoracolumbar fracture with more than 50％vertebral height loss were treated with the novel percutaneous self-expanding forceful reduction screw between March 2014 and June 2015.The screw system is a single plane screw with a reduction angle of 0,3,6,9 degrees.During the operation,the fracture vertebral body was automatically restored during the locking process of the top cap.All the patients were single vertebral fractures.Percutaneous screw fixation and reduction was used in the operation.Two groups of screws were used to fix the two adjacent vertebrae of the injured vertebra and to restore the injured vertebral body,without fusion treatment.The vertebral body index (VBI),height of the anterior margin of fractured vertebra (HAMFV),vertebral body angle (VBA),bisegmental Cobb angle (BCA),visual analog scale (VAS) and Oswestry disability index (ODI) of the patients before and after operation,6 months after operation,and at the end of the follow-up were compared.The scoring results were compared using a t test.Results The operation was completed successfully in 38 cases.A total of 152 screws were placed.The accuracy rate of CT evaluation was 98.7％.The average operation time was 90.7±21.9 min,and the average intraoperative bleeding amount was 89.2±31.9 ml.The patients' preoperative VBI,HAMFV,VBA,BCA,VAS and ODI scores were 0.38±0.07,0.38±0.06,25.45°±4.54°,18.66°± 8.57°,7.76± 1.02,and 44.58％±2.33％,respectively.The postoperative measurements were 0.93±0.03,0.95±0.02,3.71°± 1.35°,5.84°±6.80 °,4.29± 1.16 and 24.37％± 1.88％.At the last follow-up,the measurements were 0.92±0.03,0.94±0.02,3.89° ± 1.31 °,6.05°±7.00°,1.71 ±0.65 and 5.95％±2.67％.There was significant difference between the preoperative and postoperative data,as well as the preoperative and the last follow-up data (P＜0.05).Conclusion In the treatment of thoracolumbar fractures with severe loss of vertebral height,the novel percutaneous self-expanding forceful reduction screw system has achieved satisfactory vertebral height restoration and kyphosis correction.