经椎间孔椎体间植骨与单纯后外侧植骨治疗胸腰段脊柱骨折脱位的比较研究  

COMPARATIVE RESEARCH OF TRANSFORAMINAL LUMBAR INTERBODY FUSION AND POSTERIOR LATERAL FUSION IN TREATMENT OF THORACOLUMBAR SPINE FRACTURE AND DISLOCATION

作　　者：李涛[1] 张进[1] 宋跃明[1] 刘浩[1] 龚全[1] 刘立岷[1] 曾建成[1] 

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中国修复重建外科杂志》2008年第11期1330-1333,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的比较胸腰段脊柱骨折脱位后路手术不同植骨方式的临床疗效。方法2005年1月-2007年7月,后路切开复位椎弓根钉棒系统内固定治疗胸腰段脊柱骨折脱位患者35例,男22例,女13例;年龄17～53岁。其中14例行经椎间孔椎体间植骨(transforaminal interbody fusion,TLIF),21例行单纯后外侧植骨(posterior lateral fusion,PLF)。TLIF组AO分型:A3型3例,B型7例,C型4例;按美国脊髓损伤协会(American Spinal Injury Association,ASIA)神经功能损伤标准评分:运动评分(50.6±3.6)分,感觉评分(170.5±42.7)分。PLF组AO分型:A3型4例,B型10例,C型7例;按ASIA神经功能损伤标准评分:运动评分(50.8±4.2)分,感觉评分(153.8±23.7)分。两组一般资料差异均无统计学意义(P>0.05)。结果TLIF组手术时间(316±32)min,PLF组(254±27)min;TLIF组术中出血量(487±184)mL,PLF组(373±72)mL;差异均有统计学意义(P<0.05)。患者术后切口均Ⅰ期愈合,无死亡、神经功能损害加重及内固定器械松动断裂等并发症发生。35例均获随访,随访时间9～23个月,平均14.6个月。术后TLIF组胸腰椎骨性融合率为100%,PLF组融合率为85.7%;两组差异有统计学意义(P<0.05)。术后3个月按ASIA神经功能损伤标准评分,TLIF组运动评分增加(10.4±10.0)分,感觉评分增加(26.5±22.8)分;PLF组运动评分增加(9.4±9.3)分,感觉评分增加(28.8±28.4)分;两组比较差异无统计学意义(P>0.05)。术后即刻、3、6及12个月椎体高度恢复TLIF组分别为(5.4±2.1)、(5.4±1.9)、(5.4±1.4)、(5.3±1.3)mm,PLF组分别为(5.3±2.6)、(5.3±2.2)、(4.8±3.1)、(4.2±3.6)mm;术后即刻、3、6及12个月Cobb角恢复TLIF组分别为(14.5±3.5)、(14.5±3.6)、(14.4±3.4)、(14.4±3.6)°,PLF组分别为(14.3±2.7)、(14.2±3.1)、(12.2±2.8)、(11.7±3.3)°;以上两指标两组术后即刻与术后3个月比较差异均无统计学意义(P>0.05),术后即刻与术后6、12个月比较差异有统计学意义(P<0.05)。结论TLIF较PLF治疗胸腰段脊柱骨Objective To compare the therapeutic effect of transforaminal lumbar interbody fusion （TLIF） and posterior lateral fusion （PLF） in treatment ofthoracolumbar spine fracture and dislocation. Methods From January 2005 to July 2007, 35 patients （22 males, 13 females, aged 17-53 years old） with thoracolumbar spine fracture and dislocation （T11-L3） received posterior open reduction and pedicle nail-stick system internal fixation. Among which, 14 patients underwent TLIF （group TLIF）, and the rest 21 patients underwent PLF （group PLF）. According to AO classification, group TLIF had 3 cases of A3, 7 cases of B and 4 cases of C, while group PLF had 4 cases of A3, 10 cases of B and 7 cases of C. Based on American Spinal Injury Association （ASIA） Scoring Standard formulated in 2000, the motor score of group TLIF and group PLF was （50.6±3.6） and （50.8±4.2） points, respectively; and the sensory score was （170.5±42.7） and （153.8 ± 23.7） points, respectively. No significant difference was noted between 2 groups in general information （P 〉 0.05）. Results The operation time of group TLIF and group PLF was （316 ± 32） minutes and （254 ± 27） minutes, and the blood loss of group TLIF and group PLF was （487 ± 184） mL and （373 ± 72） mL, indicating there were significant differences between 2 groups （P 〈 0.05）. Wounds of all patients were healed by first intention and there was no death, aggravation of neurological function impairment and complication of internal fixation instrument loosening and breaking. All 35 cases were followed up for 9-23 months with an average of 14.6 months. Postoperatively, the thoracolumbar bone fusion rate of group TLIF and group PLF was 100% and 85.7%, respectively, indicating there was a significant difference （P 〈 0.05）. At 3 months after operation, the motor score of group TLIF and group PLF was increased by （10.4 ± 10.0） and （9.4 ± 9.3） points, respectively; and the sensory score was upgraded by （26.5 ± 22.8

关 键 词：胸腰段脊柱骨折脱位 经椎间孔椎体间植骨 单纯后外侧植骨 融合率 神经功能恢复 

分 类 号：R687.3[医药卫生—骨科学]