伤椎置钉与伤椎置钉结合植骨治疗胸腰椎压缩性骨折的比较  

Comparison of clinical outcomes of injured vertebral fixation combined with fractured vertebral transpedicular bone graft for unstable thoracolumbar fracture

作　　者：齐志远[1] 陈秀民[1] 王在斌[1] 姜志圣[1] 李广彬[1] 韩鹏[1] 

机构地区：[1]濮阳市中医院骨二科,河南濮阳457003

出　　处：《临床骨科杂志》2015年第6期641-644,648,共5页Journal of Clinical Orthopaedics

基　　金：濮阳市科技攻关项目(编号:130638)

摘　　要：目的探讨短节段伤椎单侧置钉固定与伤椎置钉结合椎体内植骨治疗胸腰椎压缩性骨折的临床疗效和安全性。方法对67例胸腰椎压缩性骨折患者采用短节段经伤椎单侧置钉固定术治疗,分为两组:伤椎单侧置钉固定组37例,伤椎单侧置钉+椎体内植骨组30例。术中经脊髓造影证实所有患者均不需作椎管减压术。术前、术后3 d、术后18个月取出内固定物前和取出内固定物后6个月时,测量伤椎及其上、下相邻正常椎体的前缘高度、中间高度、伤椎后凸Cobb角,比较两组椎体前缘压缩率、矫正度丢失、术中出血量、手术时间和患者满意度。结果 67例均获得随访,时间24个月。手术时间及术中出血量伤椎单侧置钉组优于单侧置钉+伤椎椎体内植骨组,差异有统计学意义(P<0.01)。两组术后脊髓功能均有一定程度恢复。随访期间椎体高度均无严重丢失,无钉棒弯曲、松动或断裂。已取出内固定的患者伤椎椎体压缩率、后凸Cobb角无明显变化,伤椎中间高度两组差异有统计学意义(P<0.01)。两组患者满意率的差异无统计学意义(P>0.05)。结论对不需要行后路椎管减压术的胸腰椎压缩性骨折患者,短节段经伤椎单侧置钉固定可取得满意治疗效果,不提倡行椎体内植骨。Objective To assess the clinical effect,safety of short-segmental unilateral fractured vertebral pedicle screw fixation and bone graft through pedicle for unstable thoracolumbar fracture. Methods 67 cases of thoracolumbar spine fracture were retrospectively analyzed. They were divided into two groups： 37 patients were undergone shortsegmental transvertebral pedicle screws internal fixation; 30 patients were undergone short-segmental transvertebral pedicle screws internal fixation and bone graft. Intraoperative spinal angiography showed no vertebral canal decompression was necessary. In the preoperative,postoperative 3 days,postoperative 18 months（ before taking out the internal fixation） and 6 months after taking out the internal fixation,the anterior height of the injured vertebrae and the adjacent two normal vertebrae,and the Cobb angle of the injured vertebrae were measured. The compression rate,the loss of correction,the operation time,and blood loss of the two groups were compared. Results 67 patients were followed up for 24 months. Significant difference was found between the two groups in the operation time and the blood loss,and unilateral screws group were better than unilateral screws and bone graft group（ P〈0. 01）. Two groups of postoperative spinal cord function had recovered. No significant loss of correction degree was found during the followup period. The breakage of implants and loosing of pedicle screws did not occur. No significant difference was found between the two groups in the compression rate of vertebrae and Cobb angle. Significant difference was found between the two groups in the mid-height of the injured vertebrae（ P〈0. 01）. No significant difference was found between the two groups in the effective treatment（ P〈0. 05）. Conclusions For patients without posterior spinal canal decompression,simple short segmental injury vertebral unilateral transpedicular fixation can achieve satisfactory therapeutic effect,vertebral body bone graft is not advocated.

关 键 词：胸腰椎骨折 单侧置钉 植骨 

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