伤椎置钉并椎体内植骨提高胸腰椎骨折的疗效  

Improving effects on the treatment of thoracolumbar fractures with transpedicular fixing and bone grafting through fractured vertebra

作　　者：秦入结[1] 宋波[1] 史东平[1] 盛路新[1] 孙晓[1] 厉雷明[1] 

机构地区：[1]江苏省连云港市第一人民医院创伤骨科,江苏连云港222002

出　　处：《中国现代医学杂志》2012年第35期60-63,共4页China Journal of Modern Medicine

基　　金：江苏省连云港市科技局项目(No:SH1005)

摘　　要：目的比较传统后路短节段椎弓根内固定术与附加伤椎置钉并椎体内植骨椎弓根内固定术对胸腰椎骨折的疗效。方法胸腰椎不稳定骨折45例,A组24例,行单纯后路短节段椎弓根内固定术,B组21例,予传统后路手术附加伤椎置钉并椎体内植骨。比较出血量,手术时间,术前、术后即刻、末次随访伤椎前缘高度、Cobb角改变、椎管占位面积、神经功能、融合情况,并发症发生等指标。结果随访8～19个月,平均11.1个月。两组术后即刻及末次随访伤椎前缘高度、Cobb角丢失率比较差异有统计学意义(P<0.05);两组术后椎管面积改善值、脊髓神经功能改善比较差异无统计学意义(P>0.05);两组术后内固定失效、融合情况、腰背痛等并发症发生率比较,差异有统计学意义(P<0.05)。结论经典后路短节段椎弓根内固定术与附加伤椎置钉并椎体内植骨内固定术都是手术治疗胸腰椎骨折的有效方法,但后者可有效重建椎体结构,增强脊柱稳定性,减少术后并发症,尤其对复位困难的椎体骨折更有价值。[Objective] To compare the therapeutic results of transpedicular fixation and bone graft through fractured vertebra and of traditional short-segment pedicle screw fixation for treatment of thoracolum- bar fractures. [Methods] There were 45 cases in the series, 24 cases in group A and 21 cases in group B, all patients were conducted with traditional short -segment pedical screw fixation, but group B were treated with transpedicular fixation and bone graft through fractured vertebra besides above-mentioned. All patients underwent radiograph and CT scan preoperatively and postoperatively, we compared the anterior vertebral height, Cobb＇s angle, sagittal canal space, neurological functions, fusion results and complications rate when preoperation, postoperation instantly and the last follow-up time. [Results] The follow-up period was 8-19 months, the average was 11.1 months. There were significant differences in the restored vertebral height, Cobb＇s angle between group A and group B postoperation, there was no difference in improvement of spinal cord function and enlargement of abnormal cross-sectional area between group A and group B postoperation, and there were significant differences in the rate of complications such as fixation failure, bone fusion, waist back pain and so forth between group A and group B at the last follow-up time. [Conclusion] Both tradi- tional short-segment pedicle screw fixation and posterior transpedicular fixation and bone graft through frac- tured vertebra are all effective to treat thoracolumbar fractures, but the latter can reconstruct vertebral column efficiently, enhance the vertebral stability, it shows special effect when restoring fractured vertebra difficultly.

关 键 词：脊柱骨折 骨折固定术 椎弓根 骨移植 

分 类 号：R687.3[医药卫生—骨科学]