外固定器联合经皮椎体植骨微创治疗胸腰椎爆裂性骨折的影像学评价  

Percutaneous transpedicular bone grafting after external spinal skeletal fixation for thoracolumbar burst fracture: radiologic evaluation

作　　者：宋西正[1] 王文军[1] 宋林章[1] 姚女兆[1] 王麓山[1] 王程[1] 李学林[1] 

机构地区：[1]南华大学附属第一医院脊柱外科,湖南421001

出　　处：《脊柱外科杂志》2012年第1期17-21,共5页Journal of Spinal Surgery

基　　金：2011年湖南省自然科学省市联合基金(11JJ8007)

摘　　要：目的探讨经皮外固定技术治疗胸腰椎爆裂性骨折的影像学变化结果。方法 2007年1月～2008年12月,对39例采用外固定联合经皮椎体植骨术治疗的胸腰椎爆裂性骨折患者进行临床随访观察。测量并计算术前、术后、拆外固定前及末次随访时的局部后凸角、椎体前缘高度丢失率及椎管狭窄率,并进行统计学分析,探讨该术式治疗胸腰椎爆裂性骨折的疗效。结果 39例患者平均随访37.6个月,骨折节段分布为T9～L4。神经功能按美国脊柱创伤学会(American Spinal Injury Association,ASIA)神经功能分级标准分级:D级8例,E级31例;8例D级患者于术后3周～3个月均恢复为E级,随访无神经功能损伤加重病例出现。术后的局部后凸角、椎体前缘高度及椎管狭窄率均明显改善,与术前相比差异有统计学意义(P<0.01);末次随访时局部后凸角及椎体前缘高度均有少量丢失,但与术前相比差异仍有统计学意义(P<0.01),椎管狭窄率无丢失。结论采用外固定联合经皮椎体植骨术治疗胸腰椎爆裂性骨折可获得良好的矫形效果,是一种胸腰椎骨折可靠的治疗方法。Objective To explore the radiologic outcomes of percutaneous transpedicular bone grafting（PTBG） after external spinal skeletal fixation（ESSF） for thoracolumbar burst fracture.Methods A retrospective review was performed on 39 patients with thoracolumbar burst fractures treated by PTBG after ESSF from January 2007 to December 2008.The local kyphotic angle（LKA）,rate of anterior height（RAH）,and spinal canal narrowing rate（NR） were measured and statistically analyzed before operation,after operation,before removing the fixator,and at the final follow-up.Results The duration of mean follow-up was 37.6 months in the 39 patients.The injured vertebrae ranged T9-L4.According to the American spinal injury association（ASIA） standards for neurological and functional classification of spinal cord injury,there were 8 cases of grade D and 31 cases of grade E before treatment.Neurological deficits were improved in the 8 patients of grade D,who were graded E 3 weeks to 3 months postoperatively and no neurological injury became more severe during the follow-up.Postoperative LKA,RAH and NR were significantly decreased,and the differences between preoperative and postoperative data had statistical significance（P0.01）.There was a little loss of LKA and RAH and no change of NR was found at the final follow-up,but the differences had statistical significance compared with pre-operation（P0.01）.Conclusion Additional PTBG after ESSF is a reliable surgical method for thoracolumbar burst fractures.

关 键 词：胸椎 腰椎 脊柱骨折 外固定器 骨移植 外科手术 微创性 随访研究 

分 类 号：R683.2[医药卫生—骨科学]