应用三维植骨器植骨治疗胸腰椎骨折的早期影像学分析  

Early imaging analysis of transpedicular intracorporeal grafting by using a three-dimensional bone grafting instrument for the treatment of thoracolumbar fractures

作　　者：庄苏阳[1] 汤文浩[1] 吴小涛[1] 张绍东[1] 王锋[1] 

机构地区：[1]东南大学附属中大医院脊柱外科,南京210009

出　　处：《中国矫形外科杂志》2014年第24期2224-2228,共5页Orthopedic Journal of China

基　　金：国家自然科学基金资助(编号:81201423)

摘　　要：[目的]评价应用三维植骨器经椎弓根行椎体内植骨、复位终板的早期影像学效果。[方法]将2010年1月-2013年12月收治的40例Denis B型胸腰椎骨折患者按照入院顺序随机分为两组：三维植骨器组和植骨漏斗组。三维植骨器组应用自行研制的椎体三维植骨器经椎弓根进行终板复位、植骨;植骨漏斗组应用传统的漏斗形植骨器经椎弓根植骨。术后一周行X线摄片及CT二维扫描,测量两组手术前后伤椎前缘高度、正常椎前缘高度、伤椎终板高度、正常椎终板高度等,计算前高矫正率、终板矫正率和椎体缺损区的体积。[结果]三维植骨器组和植骨漏斗组的术前前高分别为（1.6±0.23）cm和（1.8±0.19）cm;术后前高分别为（2.82±0.23）cm和（2.66±0.26）cm;正常椎体前缘高度分别为（2.96±0.32）cm和（2.91±0.36）cm;术后伤椎终板高度分别为（2.34±0.22）cm和（1.84±0.31）cm;正常终板高度分别为（2.42±0.18）cm和（2.48±0.23）cm。三维植骨器组和植骨漏斗组的前高矫正率分别为（95.3±3.6）%、（91.8±4.2）%（P〉0.05）;终板矫正率分别为（93.6±5.8）%、（72.5±6.4）%（P〈0.05）;椎体缺损区的体积分别为（0.76±0.14）cm3、（2.53±0.29）cm3（P〈0.05）。[结论]三维植骨器可以有效地复位塌陷的终板、消灭椎体内骨缺损区,为胸腰椎骨折的治疗提供新型的植骨工具。[Objective] To conduct early imaging analysis of transpedicular bone grafting by using a three -dimensional （3D） bone grafting instrument for treatment of thorsacolumbar fracture. [ Method ] Forty patients with Denis type B thoracolum- bar burst fracture treated between 2010 and 2013 were randomly divided into two groups according to method of transpedicular bone grafting. Patients in group A underwent grafting by using a 3D bone grafting instrument,while patients in group B under- went grafting by using a bone grafting funnel. Radiography and computed tomography （CT） were performed 1 week postopera- tively. Measurements included the anterior height of injured vertebra, anterior height of normal vertebra, middle height between endplates of injured vertebra,and middle height between endplates of normal vertebra,as observed on radiography and CT. The ratio between anterior heights of injured vertebra and normal vertebra （AHVR） ,ratio between middle heights between endplates of injured vertebra and normal vertebra （MHER）, and volume of vertebral bone defect were also calculated. [ Result ] The ante- rior height of injured vertebra in groups A and B,respectively,were 1.6±0.23 cm and 1.8 ±0.19 em preoperatively,and 2.82 ±0.23 cm and 2.66±0.26 cm postoperatively. The anterior height of injured vertebra in groups A and B was 2.96±0.32 cm and 2.91 .0.36 cm respectively. The postoperative middle height between endplates of injured vertebra in groups A and B was 2.34 .0.22 cm and 1.84±0.31 cm,respectively,while the middle height between endplates of normal vertebra was 2.42 ±0.18 cm and 2.48 ±0.23 cm,respectively （P 〉0.05）. The AHVR was 95.3% ±3.6% in group A and 91.8% ±4.2% in group B. The MHER was 93.6%±5.8% in group A and 72.5%±6.4% in group B （P 〈 0.05 ）. The volume of vertebral bone de- fects in groups A and B was 0.76±0.14 cm3 and 2.53±0.29 3 cm , respectively （ P 〈 0.05）. [ Conclusion ] The 3 D bone graft- ing instrument is effective in reduction of endplate fractures

关 键 词：胸腰椎骨折 植骨术 经椎弓根 三维植骨器 影像学分析 

分 类 号：R687.3[医药卫生—骨科学]