后路内固定结合经伤椎椎弓根植骨治疗胸腰椎爆裂性骨折  

Posterior internal fixation with transpedicle bone graft for thoracolumbar burst fracture

作　　者：戴斌[1] 沈海滨[1] 周克中[1] 李道龙[1] 王金荣[1] 陈东[1] 许建安[2] 吕锦瑜[2] 李志伟[2] 

机构地区：[1]滨海县人民医院骨科,江苏滨海224500 [2]江苏省中医院骨伤科,江苏南京210029

出　　处：《临床骨科杂志》2012年第2期136-139,共4页Journal of Clinical Orthopaedics

摘　　要：目的探讨后路内固定结合经伤椎椎弓植骨治疗胸腰椎爆裂性骨折的临床效果。方法将60例胸腰椎爆裂性骨折患者按手术方法分为两组:实验组(后路钉棒固定结合经椎弓根植骨)30例,对照组(常规内固定后外侧植骨)30例。观察术前、术后1周、术后3个月及术后12个月椎体高度压缩率、伤椎Cobb角、骨折愈合情况及内固定并发症,并进行比较分析。结果 60例均获随访,时间12～18(14.9±4.8)个月。两组术前、术后1周、术后3个月的椎体高度压缩率、Cobb角比较差异均无统计学意义(P>0.05);术后12个月两组椎体高度压缩率、Cobb角比较差异有统计学意义(P<0.01)。实验组疗效优于对照组。术后3个月实验组椎体骨折愈合12例,对照组5例;末次随访时实验组无内固定并发症发生,对照组出现3例断钉、2例螺钉松动退出。神经功能评分均较术前有明显改善,两组间比较差异无统计学意义(P>0.05)。结论后路内固定结合经伤椎椎弓根植骨治疗胸腰椎爆裂性骨折,能促进骨折愈合,恢复椎体前中柱支撑,减少伤椎高度丢失和后凸畸形,减少内固定并发症发生率。Objective To investigate the clinical effects of posterior internal fixation with transpedicle bone graft for thoracolumbar burst fracture. Methods 60 cases with thoracolumbar burst fractures were divided into two groups according to surgical methods： the experimental group underwent posterior pedicle screw fixation with transpedicular bone grafting of 30 patients, while the control group underwent only posterior fixation with posterolateral bone graft of 30 patients. Vertebral height compression, vertebral Cobb angle, fracture healing, fixation complications between 2 groups were reviewed and compared. Results 60 patients were followed up for 12 - 18 （ 14.9 ＋ 4. 8） months. Pre- operation, postoperation 1 week and 3 months, compression of vertebral height and Cobb angle was no significant difference between the two groups （P 〉 0. 05）. The incidence of complications of fixation, compression of vertebral height and Cobb angle between the two groups was statistically significant at postoperative 12 months（ P 〈 0. 01 ）. Experimental group was better than the control group. There were 12 cases of healing of vertebral fractures in the experimental group at postoperative 3 month, while there were 6 cases in control group. The experimental group was no internal fixation complications, and there were 5 cases suffered instrument failure in control group at postoperative 12 months（3 cases of screw breaking and 2 case of screw loosening）. Compared with preoperative, neurological score was significantly improved after operation, but there were no statistically difference （ P 〉 0.05）. Conclusions Posterior internal fixation with transpedicle bone graft for thoracolumbar burst vertebral fractures can promote healing and restore anterior column support, reduce the loss of vertebral height and kyphosis, and reduce the incidence of complications of fixation.

关 键 词：脊柱骨折 爆裂性骨折 胸腰椎 经椎弓根 骨移植 内固定器 

分 类 号：R683.2[医药卫生—骨科学] R687.3[医药卫生—外科学]