经伤椎椎弓根植骨联合椎弓根钉内固定系统治疗胸腰椎爆裂性骨折  

Transpedicular bone grafting combined with pedicle screw fixation system for treatment of thoracolumbar burst fractures

作　　者：刘小鹏[1] 颜春铭[1] 郭伟华[1] 吴任涛[1] 王虎[1] 孙景福[1] 陈淑玲[1] LIU Xiao-peng;YAN Chun-ming;GUO Wei-hua;WU Ren-tao;WANG Hu;SUN Jing-fu;CHEN Shu-ling(Department of Orthopaedics,Dongguan Houjie Hospital,Dongguan 523900,Guangdong,China)

机构地区：[1]东莞市厚街医院骨科,广东523900

出　　处：《脊柱外科杂志》2018年第6期340-343,348,共5页Journal of Spinal Surgery

基　　金：东莞市社会科技发展项目(201650715001490)

摘　　要：目的探讨经伤椎椎弓根植骨联合椎弓根钉内固定系统治疗胸腰椎爆裂性骨折的临床效果。方法 2014年5月—2016年1月,共收治胸腰椎单节段爆裂性骨折患者73例,其中前期35例采用椎弓根钉内固定系统进行治疗(A组),后期38例采用经伤椎椎弓根植骨联合椎弓根钉内固定系统治疗(B组)。记录并比较2组患者术前、术后伤椎前缘高度、后凸Cobb角、美国脊髓损伤协会(ASIA)分级以及腰痛情况。结果所有患者均顺利完成手术。末次随访时,B组伤椎前缘高度显著高于A组,Cobb角显著小于A组,远期椎体高度及Cobb角丢失率显著低于A组,差异均有统计学意义(P <0.05)。末次随访时,B组患者术后ASIA分级情况显著优于A组,差异有统计学意义(P <0.05)。B组术后腰痛整体情况优于A组,其中无痛例数显著多于A组,中度疼痛例数显著少于A组,差异均有统计学意义(P <0.05)。结论经伤椎椎弓根植骨联合椎弓根钉内固定系统治疗胸腰椎爆裂性骨折,可有效恢复伤椎椎体高度,改善伤椎稳定性,有助于神经功能的恢复,减少腰痛等并发症的发生,疗效显著,值得推广。Objective To explore the clinical effect of transpedicular bone grafting combined with pedicle screw fixation system in the treatment of thoracolumbar burst fracture.Methods From May2014to January2016,73patients with singlelevel thoracolumbar burst fracture were treated,35in the early stage were treated with pedicle screw internal fixation system(group A)and38in the late stage with transpedicular bone grafting combined with pedicle screw fixation system(group B).The anterior vertebral height,kyphosis Cobb’s angle,American Spinal Injury Association(ASIA)classification and low back pain before and after the operation were recorded and compared between the 2 groups.Results All the patients completed the operation successfully.At the final follow-up,the anterior vertebral height was significantly higher,but Cobb’s angle smaller in group B than in group A,and the long-term loss rate of vertebral height and Cobb’s angle were significantly lower in group B than in group A;the differences were statistically significant(P<0.05).At the final follow-up,the ASIA classification was significantly better in group B than in group A,and the difference was statistically significant(P<0.05).The overall situation of postoperative low back pain was better in group B than in group A,and the number of non-pain cases was significantly higher in group B than in group A,and the number of moderate pain cases was significantly lower in group B than in group A;the differences were statistically significant(P<0.05).Conclusion The treatment of thoracolumbar burst fracture by transpedicular bone grafting combined with pedicle screw fixation system can effectively restore the height of injured vertebral body,improve the stability of injured vertebral body,help to restore nerve function,reduce the occurrence of complications such as low back pain,and the therapeutic effect is remarkable and worthy of popularization.

关 键 词：胸椎 腰椎 脊柱骨折 骨移植 内固定器 

分 类 号：R683.2[医药卫生—骨科学]