人工椎体在胸腰椎病变中的应用.docVIP

　　人工椎体在胸腰椎病变中的应用 作者：徐皓，唐焕章，符臣学，张朝春，钟继平，林松庆，陈宗雄 【摘要】 ［目的］观察人工椎体在胸腰椎肿瘤、结核及骨折 治疗 中的外科疗效。［ 方法 ］对169例胸腰椎患者（其中包括64例肿瘤、66例结核、39例爆裂性骨折）的外科疗效进行回顾性 分析 。其中有57例伴有胸腰椎后凸畸形，术前Cobbs角27.1°～65.4°，平均（38.5±10.7）°。对所有患者进行病变椎体大部或完整切除，椎间撬拔撑开复位，可调式中空笼状钛合金人工椎体植骨替代，辅以前路椎体钉板（棒）系统或后路椎弓根钉系统行邻近椎节固定，Ⅰ期重建脊柱稳定性，观察术后局部疼痛缓解，脊髓神经功能恢复、脊柱椎节的稳定性及后凸畸形的矫治情况。［结果］随访12～46个月，平均32个月。所有患者术后疼痛缓解，肿瘤、结核病人术后局部均无复发，脊髓神经功能无加重损伤，73例患者脊髓神经功能得到不同程度恢复。术后影像学检查提示：脊柱内固定物在位，椎体序列恢复良好，椎间高度恢复。后凸畸形者术后矫正角度（31.6±8.3）°，最后随访时矫正角度丢失（4.1±3.8）°。［结论］胸腰椎病椎切除、人工椎体植骨替代并内固定，能彻底减压、缓解疼痛，能有效重建脊柱稳定，恢复脊柱序列。 【关键词】 人工椎体； 胸腰椎； 重建； 外科治疗 　　Application of artificial vertebral body in lesions of thoracic and lumber vertebra∥ 　　Abstract：［Objective］To observe the clinical results of adjustable hollo artificial vertebra in the treating of tumor,tuberculosis and severe burst fracture of the thoracic and lumber vertebra.［Method］Totally 169 cases of thoracolumbar fractures or,66 cases of tuberculosis and 39 cases of severe burst fracture of the thoracic and lumber spine,of ean（38.5±10.7）degrees,plant adjustable hollo artificial vertebral body,anterior internal fixation or posterior transpedicular fixation,reconstruction of spinal stability.For anterior stabilization,the Centaur plate system,Zplate and XIAⅡrodscre onitored.［Result］Postoperatively,the period of folloonths to 46 months ean of 32 months.All these patients had thEir incision healed by first intention,and no recurrence or and tuberculosis.All patients experienced significant palliation local pain,and 73 patients shoproved neurological status（at least one grade improvement on Frankels functional classification）. The instrumentation provided immediate stability and protected against development of kyphotic deformity in all patients.Postoperative radiological evaluation revealed that implants ena of prosthesis subsidence,hook dislodgment and failure restoration of spinal segments hEIght.Solid bony fusion ity had been corrected by（31.6±8.3）degrees ean（6.2±8.7）degrees after operation.［Conclusi