单纯椎弓根钉器械复位固定不行植骨融合治疗胸腰椎爆裂骨折探讨  

Thoracolumbar burst fractures treated with transpedicular instrumentation without fusion

作　　者：蔡福金[1] 骆宇春[1] 朱建平[1] 于晓华[1] 金根洋[1] 刘晓晖[1] 汪建良[1] 陈伟南[1] 胡超[1] 肖俊[1] 

机构地区：[1]解放军第101医院骨科,江苏无锡214044

出　　处：《颈腰痛杂志》2010年第1期3-7,共5页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的通过评价单纯椎弓根钉器械复位固定不行植骨融合这一方法对无明显神经损伤的不稳定性胸腰椎爆裂骨折的疗效,探讨其临床可行性。方法对63例(后突大于20°和/或椎体前缘塌陷大于50%)行单纯椎弓根器械复位内固定而不行植骨融合的无明显神经损伤的不稳定性胸腰椎爆裂骨折患者进行了最短为2年的随访,所有患者于术前、术后、及术后24月随访时拍正侧位X片以及行损伤椎体及上下相邻椎体的CT检查(其中63例获得了术前、28例术后即刻、以及25例术后24个月时的CT资料)。于侧位片测量Cobb角(通过邻近椎体)表示成角畸形程度;测量椎体前缘高度丢失表示椎体前部塌陷程度;于CT片上测量椎管正中矢状径(Midsagital diameter MD)表示椎管占位程度;于2年最后随访时63例均获得下腰痛评分表(Low Back Outcome Score,LBOS)。结果63例最后随访时LBOS评分优者46例(优良率88%),中5例(8%),3例(4%)为差;Cobb's角术前平均为20.1°,术后平均为6.2°,最后随访时为11.9°;椎体前缘高度丢失术前平均为49.1%,术后为17.4%,最后随访时为20.4%;椎管正中矢状径术前(n=63)平均49.8(%),术后(n=28)平均78.1(%),最后随访时(n=25)平均为91.7(%);有5例(8%)由于内固定部件断裂致内固定失败;最后随访时影像学参数(Cobb角、椎体前缘高度和椎管正中矢状径)与LBOS评分无明显相关性。结论单纯椎弓根钉器械复位固定不行植骨融合这一方法对无明显神经损伤的不稳定性胸腰椎爆裂骨折的疗效是满意的,对这种类型骨折治疗常规行后外侧融合是不必要的。Objective To determine the outcome of patients with thoracolumbar burst fractures who were treated with transpedicular instrumentation without fusion.Methods 63 patients with thoracolumbar burst fractures（the inclusion criteria was neurologically intact spine with a kyphotic angle〉20° and/or decreased anterior vertebral body height〉50%）who were treated with transpedicular instrumentation without fusion.were studied and followed up for at least two years.All patients underwent a radiological and clinical assessmen（tincluding the loss of kyphotic angle,decreased anterior vertebral body height,the midsagital diameter of the canal and the Low Back Outcom Score） preoperatively,postoperatively and after 24 months.Results 55 patients（88%） achieved excellent and good results with the Low Back Outcome Score,while 5（8%） were assessed fair and 3（4%）obtained a poor result.The change of the average anterior vertebral body height was 49.1% preoperatively,17.4% postoperatively and 20.4% after 24 months.The Cobb’s angle was 20.1° preoperatively,6.2° postoperatively,and 11.9° after 24 months.The MD was 49.8%（n=63） preoperatively,78.1%（n=28）postoperatively,and 91.7%（n=25）after 24 months.The implant failure rate was 8% of patients.The radiographic parameters were not significant factors affecting the outcome of LBOS.Conclusion the results of transpedicular instrumentation without fusion for surgically treated burst fractures of the thoracolumbar spine were satisfactory. We consider that routine posterior or posterolateral fusion is unnecessary in the operative management of these fractures.

关 键 词：胸腰椎爆裂骨折 椎弓根器械 内固定 植骨融合 

分 类 号：R683.21[医药卫生—骨科学] R687.32[医药卫生—外科学]