重组人骨形态发生蛋白-2联合椎体内植骨经伤椎后路置钉治疗A型胸腰椎骨折的效果  

Effects of recombinant human bone morphogenetic protein-2 combined with pedicle screw fixation via dorsal-approach and vertebral body bone graft in treating type A thoracolumbar vertebral fractures

作　　者：胡磊[1] 丁伟[1] 余俊[1] 李杰[1] 

机构地区：[1]安徽省池州市人民医院骨一科,247000

出　　处：《中华创伤杂志》2017年第8期737-742,共6页Chinese Journal of Trauma

基　　金：安徽省池州市科技局医学科技创新项目（20130082）

摘　　要：目的探讨重组人骨形态发生蛋白-2（rhBMP-2）对后路伤椎置钉椎弓根内固定联合椎体内植骨治疗A型胸腰椎骨折效果的影响。方法采用回顾性病例对照研究分析2012年6月-2015年7月收治的64例A型胸腰段骨折患者临床资料，按随机数字表法分为对照组和研究组。对照组32例（行后路伤椎置钉复位内固定＋同种异体松质骨经椎弓根椎体内植骨），其中男22例，女10例；年龄（48．2±11．2）岁。受伤节段：T11 2例，T12 4例，L1 9例，L2 7例，L1 7例，L4 3例。研究组32例（在对照组的基础上用rhBMP-2与同种异体松质骨混合植入），其中男24例，女8例；年龄（50．7±11．4）岁。受伤节段：T．．2例，T12 4例，L1 8例，L2 8例，L3 7例，L4 3例。比较两组手术时间、术中出血量、术后引流量、伤椎恢复情况、Lane—Sandhu评分、骨折愈合时间及术后并发症。结果两组手术时间、术中出血量、术后引流量差异均无统计学意义（P〉0．05）°术后1周Cobb角、伤椎前缘高度差异无统计学意义（P〉0．05）°术后12个月研究组Cobb角[（6．3±1．1）°]显著小于对照组[（10．0±2．4）°]（P〈0．05），而伤椎前缘高度[（89．2±2．1）％]显著高于对照组[（84．5-4-3．8）％]（P〈0．05），且均优于术前（P〈0．05）°术后12个月研究组Cobb丢失角[（2．0±0．7）°、伤椎前缘丢失高度[（3．2±1．0）％]均小于对照组[（5．6±1．7）°、（6．8±2．4）％]（P〈0．05）°研究组骨折Lane—Sandhu评分[（8．9±0．8）分]和骨折愈合时间[（6．9±0．9）个月]均优于对照组[（6．8±0．8）分、（8．4±1．6）个月]（P〈0．05）°研究组并发症总发生率（3％）低于对照组（13％），但差异无统计学意义（P〉0．05）°结论与单纯后路伤椎置钉椎弓根内固定椎体内植骨比较，后路伤椎置钉椎弓根内固定椎体内植骨联合rhBMP-2治疗A型胸Objective To observe the effects of recombinant human bone morphogenetic protein-2 （rhBMP-2） on patients with type A thoracolumbar fractures treated by pediele screw fixation via dorsal- approach and vertebral body bone graft. Methods A retrospective ease-control study was conducted to analyze the clinical data of 64 patients with type A thoracolumbar fractures treated from June 2012 to July 2015. The patients were divided into control group （32 eases） and research group （32 cases） according to the random number table. There were 22 males and 10 females aged （48.2 ± 11.2 ）years old in control group. The injury was located at T11 in2 eases, T12 in4, Lj in9, L2 in7, L3 in7 and L4 in3 in control group. There were 24 males and 8 females aged （50.7±11.4） years old in research group. The injury was located at Tllin 2 cases, Tl2in 4, Llin 8, L2 in 8, L3 in 7 and L4 in 3. The control group was treated with posterior pedicle screw reduction, internal fixation and allograft cancellous bone grafting through pedicle of vertebral arch. The research group was treated with rhBMP-2 （ mixed with cancellous bone implants） on the basis of the control group. The time of operation, the amount of bleeding during operation, the volume of postoperative bleeding, the amount of postoperative drainage, the recovery of the injured vertebra, the Lane-Sandhu score, the time of fracture healing, and the postoperative complications were compared. Results There was no difference between two groups on operation time, amount of bleeding during operation or amount of postoperative drainage （ P 〉 0.05 ）. No difference existed in two groups about Cobb angle and injured vertebral leading edge height at one week after operation （P 〉 0.05 ）. At the time of last follow-up （ 12 months） , in research group, Cobb angle was lower while injured vertebral leading edge height was much higher than that of control group （ P 〈 0.05 ） , both of which were better than before （P 〈 0.05）. At 12 months after surgery

关 键 词：脊柱骨折 胸椎 腰椎 骨形态发生蛋白一2 骨移植 

分 类 号：R687.3[医药卫生—骨科学]