经椎弓根人工骨植入并后路椎弓根钉内固定材料置入治疗胸腰椎爆裂骨折  

Transpedicular bone graft and posterior pedicle screw fixation in the treatment of thoracolumbar burst fractures

作　　者：徐世田[1] 李阳[2] 高峰[1] 梅继文[1] 姜洪和[1] 孙海光[1] 

机构地区：[1]吉林医药学院附属医院骨科,吉林省吉林市132013 [2]吉林市中心医院骨科,吉林省吉林市132011

出　　处：《中国组织工程研究与临床康复》2007年第48期9705-9709,共5页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：目的:加用后路植骨融合减少并发症是国内外学者均认可的有效方法,使用中大多数为横突间植骨或椎间植骨,其植骨融合率不高,术后仍然存在丢失矫正角度的问题。拟验证采用椎弓根钉系统内固定材料置入配合人工骨经椎弓根植入在预防无神经损伤的胸腰椎爆裂性骨折术后并发症中的作用和应用价值。方法:①实验对象:于2004-03/2007-02吉林医药学院附属医院骨科采用后路椎弓根钉系统撑开复位内固定材料置入并用经椎弓根植入人工骨治疗无神经症状的胸腰椎爆裂性骨折患者26例。男15例,女11例,年龄22～岁,平均45岁。合并有骨质疏松688例。CT示椎体后壁不完整并有碎骨块压迫硬膜囊,椎管变窄20%～50%。经X射线片判定均有脊柱后凸畸形;术前Cobb角6°～30°,平均26°。术前伤椎前缘压缩率50%～70%,平均60%;后缘压缩10%～15%,平均11.5%。26例均为单一椎体损伤,损伤椎体:T1210例,L112例,L24例。②实验材料:椎弓根钉系统使用国产创伤钉系列,人工骨使用美国生物材料公司生产的Nova Bone,商品名固骼生,具有良好的组织相容性,可完全生物降解,机械强度高等优点;其成骨速度快,应用在骨缺损上能即刻增加骨强度,短时间内可产生大量新生骨,促进骨愈合,是一种较好的植骨材料。③实验评估:CT与X射线片评估Cobb角和椎体压缩率改善状况,是否存在矫正角度丢失及Nova Bone吸收降解状况,有无不良反应。VAS评分标准评估脊柱活动度,腰背痛及下肢痛情况。结果:26例患者术后疼痛均明显缓解,椎体高度和形态得到明显恢复,Cobb角平均改善11.5°,椎体压缩率改善50%。Nova Bone比较均匀分布于伤椎骨缺损间隙中,无泄漏现象发生。经平均20.5个月随访,疼痛均消失,骨折均达到满意复位并骨性愈合,Nova Bone均完全降解,无Cobb角明显加大,未发现明显并发症。结论:后路椎弓根钉系统固定材料置入加经AIM： Posterior bone graft fusion is effective to reduce complications, which is accepted by abroad and domestic scholars, and intertransverse or intervertebral graft is dominant, but the fusion rate is low and the correction angle is still not lost, This paper was designed to verify the application value of pedicle screw internal fixation combined with transpedicle graft of artificial bone in preventing postoperative complication of patients with thoracolumbar vertebral burst fractures without neurological injury. METHODS： （1） From March 2004 to February 2007, 26 cases of thoracolumbar vertebral burst fractures without neurological symptoms were treated by distraction reduction fixation system of posterior pedicle screw in combination with transpedicle artificial bone graft in the Department of Orthopaedics, the Affiliated Hospital of Jilin Medical College. The patients included 15 males and 11 female, in which 8 cases suffered osteoporosis, and they all aged 22-68 years with a mean of 45 years. It was shown in CT result that posterior vertebral wall was incomplete and dural sac was compressed to turn narrow by 20%-30%. All the patients were diagnosed as kyphosis by using X-ray radiograph. Preoperatively, Cobb angle was 6°-30° with an average of 26°, anterior vertebral body was compressed 50%-70% with an average of 60%, and compression ratio of posterior vertebral margins was 10%-15% with an average of 11.5%. All of cases were single vertebral fractures and range of vertebral destruction involved in 10 cases of T12, 12 cases of L1 and 4 cases of L2.（2）Pedicle screw internal fxation system was adopted domestic wound nail, and artificial bone was the production of American Biomaterials Company （Nova Bone）, which possessed good biocompatibility, complete biodegradation and high mechanical strength, Due to the rapid bone formation rate, Nova bone was detected to immediately increase the bone strength, induce a large amount of bone formation in short term, and promote bone healing, thus it was consi

关 键 词：胸腰椎爆裂骨折 椎弓根钉固定术 植骨术 骨质疏松 固骼生 

分 类 号：R318[医药卫生—生物医学工程]