经椎弓根植骨在伴有骨质疏松的胸腰椎骨折中的应用  

Application of transpedicular bone grafting on osteoporotic thoracolumbar fractures

作　　者：曹治东 李邦春 苟景跃 邓志龙 张奎 胡建华 田开熙 晏伟 

机构地区：[1]重庆市第四人民医院骨科重庆市急救医学研究所,400016

出　　处：《中国矫形外科杂志》2007年第6期421-423,共3页Orthopedic Journal of China

摘　　要：[目的]评价经椎弓根植骨在胸腰椎骨折中的临床疗效,为临床选择提供依据。[方法]通过病例回顾分析,根据影像学及神经功能结果,比较单纯后外侧植骨与复合经椎弓根植骨的术后即时及随访1年半以后的临床效果。[结果]2种术式的术后即时效果无差异(P>0.05),椎体前缘高度均恢复达92%左右,Cobb′s角下降约12.5°。但晚期效果复合经椎弓根植骨远较单纯后外侧植骨好(P<0.01),单纯后外侧植骨随访1年半以后椎体高度及Cobb′s角的矫正均有不同程度的丢失(8.1%/6°),并有39.3%的内固定并发症率,而复合经椎弓根植骨未发现明显的矫正丢失及内固定并发症。但最终脊髓神经功能的恢复两者无明显差异。[结论]经椎弓根植骨不但能复位骨折,重建椎体高度,更能提供脊柱即时及晚期稳定性,减少内固定并发症,特别适合老年骨质疏松性胸腰椎骨折。[ Objective] To evaluate curative effect of transpedicular bone grafting on osteoporotic thoracolumbar fractures. [ Method ] The curative effect of postero-lateral fusion combined with transpedicular bone grafting for osteoporotic thoracolumbar fractures （OTLF） （25 cases） was reviewed, analyzed and compared with that of pure posterior lateral fusion of OTLF （28 cases） , retrospectively. The vertebral height and Cobb＇s angle were measured in preoperative and postoperative radiographs, and neural function was evaluated with Frankel grade. The results of immediate postoperation and of 1.5 years follow-up were compared. [ Result] The vertebral height of fractured vertebrae recovered to 92% and Cobb＇s angle decreased 12.50 in both pure and combined method groups immediately after operation, showing no significant difference （P 〉 0.05 ）. At 1.5 years follow-up, the correction of vertebral height and Cobbg angle lost 8.1% and 6 o respectively, and internal fixation complication was found in 39. 3% cases of pure posterolateral fusion but there was no lost of correction in combined transpedicular bone grafting, showing a significant difference （P 〈0.01 ）. However, there was no significant difference in recover of spinal nerve function. [ Conclusion ] Transpedicular bone grafting for thoracolumbar fractures can not only reduce vertebral fracture but also provide and maintain vertebral stability early and long-term with decreasing fixation complications and specially fits for osteoporotic thoracolumbar fractures.

关 键 词：经椎弓根植骨 骨质疏松性胸腰椎骨折 重组异种骨 

分 类 号：R687.3[医药卫生—骨科学]