椎弓根钉固定并经椎管椎体内植骨治疗B型胸腰椎骨折的疗效分析  

Therapeutic effect of pedicle screw fixation combined with body bone graft via vertebral canal for type B thoracolumbar fracture

作　　者：刘进南 刘蓉 唐本赛 刘刚 陈谷才 LIU Jin-nan;LIU Rong;TANG Ben-sai;LIU Gang;CHEN Gu-cai(Department of Spinal Surgery,the Second People's Hospital of Qujing,Qujing,Yunnan 655000,China)

机构地区：[1]曲靖市第二人民医院脊柱外科,云南曲靖655000

出　　处：《颈腰痛杂志》2020年第3期296-298,302,共4页The Journal of Cervicodynia and Lumbodynia

基　　金：宁夏回族自治区自然科学基金(编号:NZ16212)。

摘　　要：目的探讨椎弓根钉固定并经椎管椎体内植骨治疗B型胸腰椎骨折的方法及临床效果。方法自2013年6月-2015年6月,采用椎弓根钉固定复位、椎管减压、经椎管椎体内植骨治疗B型胸腰椎骨折患者36例,男25例,女11例。对所有患者手术情况及术后疗效进行总结分析。结果所有患者手术时间(105±29)min,出血量(310±38)mL,所有患者均未输血;1例患者出现硬脊膜损伤,1例发生肠麻痹,共发生并发症2例(5.6%)。术后随访18~24个月,与术前相比,术后1周的伤椎高度比、平均后凸角(Cobb角)、平均椎管侵占率均获显著改善(P<0.05),而末次随访未见明显矫正度丢失(P>0.05);末次随访时,VAS评分及ODI评分均较术前显著降低(P<0.05),差异有统计学意义。末次随访内固定位置良好,无钉棒断裂、内固定松动;CT检查见伤椎内植骨分布较广泛、均匀,植骨与周边骨融合良好,有少数空洞形成,但脊柱无明显畸形及失稳。术前合并神经损伤者,术后ASIA分级平均提高2.3级。结论椎弓根钉撑开复位联合经椎管椎体内植骨治疗B型胸腰椎骨折,能充分、均匀地植骨,有效重建伤椎的空间结构,减少了断钉、断棒及椎体再压缩等并发症的发生,取得了良好的效果。Objective To explore the method and effect of pedicle screw fixation combined with bone graft of vertebral body via vertebral canal in the treatment of type B thorcolumbar fracture.Methods From June 2013 to June 2015,36 patients with type B thoracolumbar fracture(25 males and 11 females)were treated with pedicle screw fixation and reduction,spinal canal decompression,and transvertebral bone grafting.The operative status and postoperative efficacy of all patients were summarized and analyzed.Results The operation time of all patients was(105±29)min,and the blood loss was(310±38)mL.One patient developed dural injury,one patient developed intestinal paralysis,and a total of 2 patients(5.6%)developed complications.Compared with the preoperative results,the injured vertebra height ratio,average kyphotic angle(Cobb angle)and average spinal canal invasion rate were significantly improved one week after surgery(P<0.05),while no significant correction loss was observed at the last follow-up(P>0.05).At the last follow-up,both VAS score and ODI score were significantly lower than before surgery(P<0.05),with statistically significant differences.The position of internal fixation was good at the final follow-up,there was no bending and loosening of pedicle screws.The vertebral bone of CT image was distributed evenly,the surrounding bone graft fusion was good.There was a few of void formation,without apparent deformation of the spine and instability of the vertebral body.In patients with nerve injury before surgery,ASIA grade was increased by 2.3 grade on average after surgery.Conclusions The pedicle screw distraction reduction and bone graft of vertebral body via vertebral canal gained good therapeutic results in the treatment of type B thoracolumbar fracture.It can distribute bone graft in the vertebral body evenly,reconstruct the spatial structure of vertebral body effectively and reduce the possibility of breaking of nails and shafts and other complications.

关 键 词：胸腰椎骨折 椎弓根钉 椎体内植骨 经椎管 

分 类 号：R683.2[医药卫生—骨科学]