跨伤椎椎弓根钉内固定合并同种异体骨椎体后外侧植骨修复胸腰椎爆裂性骨折  

Pedicle screw fixation combined with posterior-lateral fusion with autogenous bone for thoracolumbar burst fractures

作　　者：董友军[1] 吴亮[1] 吴国峰[1] 周剑[1] 王锟[1] 孙晗[1] 孙晓亮[1] 

机构地区：[1]苏州大学附属第三医院骨科,江苏省常州市213000

出　　处：《中国组织工程研究》2017年第15期2342-2348,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:外科手术重塑脊柱稳定性对修复胸腰椎爆裂性骨折具有重要作用,但伤椎植骨融合能否有效阻止矫正丢失颇有争议。目的:探讨同种异体骨椎体后外侧植骨对跨伤椎椎弓根钉置入内固定修复胸腰椎爆裂性骨折疗效的影响。方法:纳入2011年1月至2015年6月收治的80例采用跨伤椎椎弓根钉置入内固定修复胸腰椎爆裂性骨折的患者,随机分为植骨组和非植骨组,每组40例,植骨组在椎弓根钉内固定基础上行同种异体骨椎体后外侧植骨。根据患者手术时间、术中出血量及术后引流量、伤口局部情况评分、Steinman脊椎融合评分,以及术前术后椎体前缘高度、Cobb角、脊髓损伤ASIA神经功能分级及Oswestry功能障碍指数变化进行临床疗效评估。结果与结论:(1)80例患者均随访24个月。植骨组的手术时间、术中出血量以及术后引流量均大于非植骨组(P<0.05);(2)与术前相比,2组患者的椎体前缘高度、Cobb角在术后均有显著改善(P<0.01),但在术后随访中,植骨组与非植骨组椎体前缘高度与Cobb角均有轻度丢失,2组之间差异无显著性意义(P>0.05);(3)与术前相比,2组患者术后脊髓损伤ASIA神经功能分级及Oswestry功能障碍指数均得到显著改善,但2组间差异无显著性意义(P>0.05);(4)结果表明,跨伤椎椎弓根钉置入内固定是修复胸腰椎爆裂性骨折一种有效安全的方法,同种异体骨虽然能与组织较好的相容,但椎体后外侧植骨并不能有效阻止术后矫正丢失,对于椎体爆裂性骨折患者或可不必使用。BACKGROUND： Spinal reconstruction plays an important role in the treatment of thoracolumbar burst fractures, but wherther the vertebral fusion can effectively reduce the loss of correction still remains controversial. OBJECTIVE： To investigate the repair effect of pedicle screw fixation combined with posterior-lateral fusion with autogenous bone for thoracolumbar burst fractures.METHODS： Eighty patients with thoracolumbar burst fractures undergoing pedicle screw fixation from January 2011 to June 2015 were enrolled, and were then randomly divided into experimental （posterior-lateral fusion with autogenous bone） and control groups （n=40 per group）. The clinical efficacy was assessed according to the operation time, intraoperative blood loss and postoperative drainage volume, wound scale scores, anterior vertebral height and Cobb angle, American Spinal Injury Association impairment scale, and Oswestry dysfunction index.RESULTS AND CONCLUSION： （1） All patients were followed up for 24 months. The operation time, intraoperative blood loss and postoperative drainage volum in the experimental group were significantly more than those in the control group （P 〈 0.05）. （2） The anterior vertebral height and Cobb angle were significantly improved in both two groups （P 〈 0.01）, and there was slight loss in vertebral height and Cobb angle in both two groups durring follow-up, but showed no significant difference between two groups （P 〉 0.05）. （3） The American Spinal Injury Association impairment scale and Oswestry dysfunction index scores were significantly improved in the two groups, but had no significant difference between two groups （P 〉 0.05）. （4） These results suggest that pedicle screw internal fixation is effective and safe for thoracolumbar burst fractures. Posterior-lateral fusion with autogenous bone allograft holds a good histocompatibility, but cannot reduce postoperative correction loss, therefore, it is not recommended for vertebral burst fractures.

关 键 词：胸椎 腰椎 骨折 内固定器 骨移植 组织工程 骨科植入物 脊柱植入物 同种异体骨 椎体后外侧植骨 椎弓根内固定系统 爆裂性骨折 

分 类 号：R318[医药卫生—生物医学工程]