经椎弓根植骨治疗胸腰椎爆裂骨折手术技巧及风险防范  

Surgical technique and risk prevention of trans-pedicle bone graft in treatment of thoraco-lumbar burst fracture

作　　者：张伟[1] 李程[1] 陈国斌 张怀成 李杨 

机构地区：[1]资中县人民医院骨科,四川资中641200 [2]内江市中医院脊柱外科,四川内江641000

出　　处：《临床骨科杂志》2015年第3期299-302,共4页Journal of Clinical Orthopaedics

摘　　要：目的探讨经伤椎椎弓根椎体内植骨治疗胸腰椎爆裂性骨折的手术技巧及风险防范。方法对38例胸腰椎爆裂性骨折患者在钉棒系统复位固定的基础上经椎弓根植骨于骨折椎体,术中根据不同节段的椎体选择穿刺进针点、外展角度、进针深度及植骨量。术前行X线、CT或MRI检查,了解骨折椎体及椎管腔内部情况,以防范手术操作中的风险。结果术后切口脂肪液化2例,经换药治疗伤口愈合。植骨块误塞入椎管腔内致截瘫1例,神经功能按Frankel分级,术前为E级,术后为B级,经及时取出植骨块后恢复为D级。所有患者均获随访,时间11~37个月。38例患者均骨性愈合,无钉棒断裂。术前椎体前、后缘高度压缩比分别为47.5%±6.3%、71.2±1.8%,内固定取出时椎体前、后缘高度压缩比分别为97.8%±1.8%,97.9%±1.6%;Cobb角度术前为23.9°±3.2°,内固定取出时为5.2°±1.8°;与术前比较差异均有统计学意义（P〈0.01）。结论经椎弓根植骨可以减少椎体骨不愈合、椎体高度丢失和钉棒断裂,但术中需精细操作以预防医源性脊髓神经损伤。Objective To explore the surgical technique and risk prevention of trans-pedicle bone graft in treatment of thoracolumbar burst fracture. Methods 38 cases of thoracolumbar burst fractures were treated with pedicle screw fixation on the basis of trans-pedicle bone graft intraoperatively. Selection of the puncture needle point,abduction angle was according to different segments of the vertebral body,the needle depth and bone. Postoperative spinal cord,nerve root injury and the extent of damage,periodic review X-ray and CT or MRI films,statistical analysis of various data were recorded. Results 2 cases got fat liquefaction and healed after dress changing. 1 case got paraplegia due to spinal canal mistakenly insertion of bone. Neurological scores by Frankel grade after preoperative for the E grade,B grade after surgery,promptly removed the bone block recovery for D grade. The patients were healed,vertebral height loss of light,no screw-rod fracture cases during 11 ~ 37 months follow-up. Preoperative vertebral edge height of compression ratio were 47. 5% ± 6. 3% and 71. 2% ± 1. 8% before and after surgery respectively; internal fixation and vertebral edge height of compression ratios were 97. 8% ± 1. 8% and 97. 9% ± 1. 6% before and after surgery respectively; preoperative Cobb angles were 23. 9° ± 3. 2°and 5. 2° ± 1. 8°before and after surgery respectively; all the differences were significantly（ P〈0. 01）. Conclusions Surgery can reduce vertebral pedicle bone nonunion,loss of vertebral height and screw-rod fracture; Iatrogenic injury of spinal cord should be avoided.

关 键 词：脊柱骨折 爆裂性骨折 椎弓根 植骨技巧 风险防范 

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