椎弓根钉棒系统联合同种异体骨移植治疗胸腰椎爆裂性骨折疗效的影像学评价  

The Imaging evaluation of the Efficacy of pedicle screw fixation combined with allogenic bone graft by the pedicle treating thoracolumbar burst fracture

作　　者：郝爱华[1] 曾庆娟[1] 高春正[2] 

机构地区：[1]山东中医药大学附属医院放射科,山东济南250014 [2]山东大学第二医院脊柱外科,山东济南250014

出　　处：《中国中西医结合影像学杂志》2016年第4期416-419,共4页Chinese Imaging Journal of Integrated Traditional and Western Medicine

基　　金：山东省科技发展计划(2014GSF118045)

摘　　要：目的 ：探讨椎弓根钉棒系统联合同种异体骨移植治疗胸腰段爆裂性骨折的作用。方法 ：回顾性分析经上述方法治疗的33例患者术前、术后的CT资料,测量术前及末次随访时椎管狭窄率、椎体前缘压缩率,以及末次随访时CT矢状位及横断位图像上伤椎骨缺损程度,观察伤椎骨性愈合情况及椎间盘内积气退变的情况。结果：33例经12-27个月随访,伤椎前缘压缩率由术前的（41.05±11.68）%矫正至术后的（11.68±2.65）%;椎管狭窄率由术前的（27.67±13.40）%矫正到术后的（7.76±6.56）%,差异均有统计学意义（均P〈0.05）。末次随访时椎体上终板骨质均存在不同程度的塌陷,伤椎骨缺损程度为（16.53±9.71）%,最大缺骨量（2.10±1.77）cm^3。19例椎体出现椎间盘积气退变,最早出现于术后2个月。结论 ：采用椎弓根钉棒系统联合同种异体骨移植治疗胸腰椎爆裂骨折,能有效维持椎体高度、重塑椎管形态,但伤椎并未完全达到骨性愈合,椎间盘退变积气率约55.9%,不能有效防止远期脊柱后凸畸形。Objective：To explore the value of transpedicular intracorporeal grafting in the treatment of patients with thoracolumbar burst fracture. Methods：33 patients treated with transpedicular intracorporeal grafting from January 2013 to March2016 and followed up for 12 -27 months were reviewed retrospectively through radiographic analysis. Radiographic measurements included spinal canal stenosis ratio and vertebral height compression ratio before surgery and late follow-up. Observed bone defect degree,vertebral bone healing and intervertebral disc degeneration of the product gas from CT sagittal and axial images at the time of the last follow-up. Results：The compression ratio of anterior vertebral was corrected from（41.05±11.68）%to（11.68±2.65）%. And spinal canal stenosis ratio was corrected from（27.67±13.40）% to（7.76±6.56）%. There was significant difference in every group（P〈0.01）. At the time of the last follow-up,vertebral endplate bone had different degrees of collapse,bone defect degree was about（16.53±9.71）%,the maximum missing bone was about（2.10±1.77）cm^3. There were 20 cases of intervertebral disc degeneration with the product of gas,first appeared in 2 months after surgery. Conclusion：The treatment of thoracolumbar burst fracture with pedicle screw rod system and allogenic bone transplantation can effectively maintain the height of vertebral body,remodeling of the spinal canal morphology,but the injured vertebra could not fully healed,intervertebral disc degeneration product gas is about 58%,can not effectively prevent long-term spinal kyphosis.

关 键 词：椎弓根内固定系统 胸腰椎爆裂性骨折 同种异体骨移植 

分 类 号：R687.3[医药卫生—骨科学] R816.8[医药卫生—外科学]