伤椎固定及经伤椎椎弓根椎体内植骨治疗胸腰段骨折  

Pedicle screw fixation and transpedical bone grafting for thoracolumbar fractures

作　　者：陈农[1] 周海林[1] 周凯华[1] 高如峰[1] 刘佐庆[1] 

机构地区：[1]复旦大学附属中山医院青浦分院骨科,上海201700

出　　处：《中国矫形外科杂志》2016年第6期525-530,共6页Orthopedic Journal of China

基　　金：上海市卫生局资助项目(编号:20124304);复旦大学附属中山医院青浦分院项目(编号:QYM2012-12);上海市医学重点专科建设资助项目(编号:ZK2012A36);上海市青浦区卫生计生系统学科带头人项目(编号:WD2015-08)

摘　　要：[目的]探讨伤椎固定及经伤椎椎弓根椎体内植骨治疗胸腰段骨折的临床疗效。[方法]2011年12月～2013年12月收治胸腰椎骨折患者共50例,随机分为两组：治疗组行短节段结合伤椎固定及椎体内植骨共25例,对照组行短节段固定共25例,比较两组手术时间、出血量、视觉疼痛程度（VAS）、伤椎前缘高度比值、Cobb角、神经功能恢复（Frankel分级）及并发症情况。[结果]术后所有患者随访6～20个月,平均11.5个月。两组手术时间比较差异有统计学意义（P〈0.05）,而术中出血量差异无统计学意义（P〉0.05）;两组患者术后3 d和末次随访VAS评分与术前相比差异有统计学意义（P〈0.05）,末次随访VAS评分治疗组优于对照组,两组比较差异有统计学意义（P〈0.05）。术后3 d和末次随访Cobb角、伤椎前缘高度比值与术前比较均有明显改善（P〈0.05）,末次随访治疗组伤椎前缘高度比值和Cobb角矫正均优于对照组,两组比较差异具有统计学意义（P〈0.05）。两组术后Frankel分级改善无明显差异。末次随访时治疗组无内固定松动、断裂和脱出;对照组中出现螺钉折弯和螺钉断裂各1例。[结论]伤椎固定及经伤椎椎弓根椎体内植骨治疗胸腰段骨折较传统短节段固定方法可更好地重建椎体高度、矫正后凸畸形和维持矫正效果,该手术方法安全而有效。[ Objective] To evaluate the clinical effect of posterior transpedical bone grafting and pedicle screw in fractured vertebra in treatment of thoracolumbar fractures. [ Method ] From December 2011 to December 2013,50 consecutive patients with one level thoraeolumbar compression/burst fracture in our department were included in this study. They were randomly di- vided into an experimental group, in which patients received transpedical bone grafting and pedicle screw in fractured vertebra（ n = 25 ） and a control group, in which traditional posterior short - segment pedicle screw fixation was given （ n = 25 ）. The results were observed and evaluated according to the operation time, intra -operational bleeding amount, VAS score, the ratio of anterior vertebral height, Cobb angle and Frankel grade. [ Result ] All the cases had been followed up for 6 to 20 months （ mean, 11.5 months ）. There was significantly statistical difference between two groups on operation time, while no significant statistical differ- ences on bleeding amount during the operation. Postoperative and final follow - up VAS score of all patients decreased obviously with a significantly statistical difference （ P 〈 0.05 ） compared to that of before surgery, at the final follow - up, VAS score in ex- perimental group decreased better than in the control group, showing significantly statistical difference （ P 〈 0. 05 ）. At three days postoperatively and final follow - up, the ratio of anterior vertebral height and Cobb angle improved obviously compared with that of before surgery, with significantly statistical differences （P 〈 0.05 ）. However, at the final follow - up, the ratio of anterior ver- tebral height and Cobb angle in experimental group improved much better than that of the control group, also indicating signifi- cantly statistical differences（P 〈 0. 05 ）. There was no significantly statistical difference between two groups on Frankel score.There was no breakage of the pedicle screw or loosening of the impl

关 键 词：胸腰椎骨折 伤椎固定 植骨 

分 类 号：R687.3[医药卫生—骨科学]