椎体间融合治疗胸腰椎骨折伴椎间盘损伤  

Interbody fusion for treatment of thoracolumbar fracture combined with intervertebral disc injury

作　　者：康辉[1] 徐峰[1] 齐凤宇[1] 张宝成[1] 王威[1] 徐彬[1] 李涛[1] KANG Hui XU Feng QI Feng-yu et al(Department of Orthopaedics, Wuhan General Hospital of PLA, Wuhan 430070, Chin)

机构地区：[1]中国人民解放军武汉总医院骨科,武汉430070

出　　处：《中国矫形外科杂志》2017年第16期1441-1444,共4页Orthopedic Journal of China

基　　金：湖北省卫计委资助项目(编号:WJ2017H0042)

摘　　要：[目的]探讨椎体间融合治疗胸腰椎骨折伴椎间盘损伤的临床疗效。[方法]对2010年3月~2014年5月收治的56例严重胸腰椎骨折伴椎间盘损伤患者的资料进行回顾性分析,其中男38例,女18例;年龄21~57岁,平均42.50岁。骨折按AO-ASIF分型:A型6例,B型39例,C型11例;神经功能根据Frankel分级:A级2例,B级4例,C级6例,D级39例,E级5例。均采用后路减压、椎弓根螺钉固定,结合椎间融合进行治疗。比较术前、术后1周、术后3个月、末次随访的VAS评分、伤椎前缘高度比、Cobb角。[结果]随访时间18~37个月,平均21.3个月,无内固定失败、无后凸畸形发生。伤椎前缘高度比由术前平均(37.19±4.60)%恢复到术后(87.11±3.75)%,末次随访时为(85.32±3.97)%,术前与术后及末次随访比较差异均有统计学意义(P<0.05);矢状面Cobb角由术前平均(20.19±2.48)°降低到术后(1.82±0.85)°,末次随访时为(2.21±0.71)°,术前与术后及末次随访比较差异均有统计学意义(P<0.05);VAS评分由术前平均(7.75±1.08)降低到术后(2.18±0.64),末次随访时为(1.37±0.75),差异有统计学意义(P<0.05)。各观察指标术后不同时间节点之间比较差异均无统计学意义(P>0.05)。[结论]采用椎间融合治疗严重胸腰椎骨折可以有效矫正后凸、维持伤椎高度,临床疗效满意。[Objective] To analyze the clinical outcome of interbody fusion for treatment of thoracolumbar iracture com- bined with intervertebral disc injury. [Method] From March 2010 to May 2014, 56 patients with severe thoracnlumbar frac- ture combined with intervertebral disc injury received interbody fusion and pedicle screw-rod fixation, included 38 males and 18 females, aged from 21 years to 57 years with an average of 42.5 years. According to AO-ASIF classification, there were 6 cases of type A, 39 type B amt 11 type C. In term of Frankel scale, 2 cases were in grade A, 4 cases in grade B, 6 cases in grade C, 39 in grade D, 5 in grade E. The visual analogue scale （VAS） , anterior vertebral body height, the sagittal Cobb an- gle were assessed to evaluate the postoperative outcome. [Results ] All patients were followed up for 18-37 months （mean, 21.3 months） . No fixation failure or kyphosis occurred in any patient. The mean anterior vertebral body height increased from （37.19±4.60） % before the surgery to （87.11±3.75） % at one week postoperatively, and （85.32±3.97） % at the last follow- up, where was statistically different compared to the data preoperatively （P〈0.05）. Conversely, the sagittal Cobb angle de- creased from （20.19±2.48） o before the surgery to （1.82±0.85） o at one week postoperatively, and （2.21±0.71） o at the last follow-up （P〈0.05） . Furthermore, the visual analogue scale （VAS） decreased from 7.75±1.08 before the surgery to 2.18±0.64 at one week post-operation, and 1.37±0.75 at the last follow-up, （P〈0.05）. However, above mentioned parameters were not significant different compared between different time points postoperatively （P〉0.05） . [Conclusion] Interbody fu- sion combined with pediele screw-rod fixation can effectively eorreet the kyphosis and maintain injured vertebral height to achieve satisfactory, clinical outcome.

关 键 词：椎间融合 胸椎 腰椎 骨折 

分 类 号：R687.3[医药卫生—骨科学]