经皮椎弓根螺钉固定结合不同经伤椎椎体内植骨方法治疗胸腰椎骨折的早期疗效比较  

Short-term effectiveness of percutaneous pedicle screw fixation combined with intravertebral allograft by different methods for thoracolumbar fractures

作　　者：丁其瑞 凡进 任永信 殷国勇 DING Qirui;FAN Jin;REN Yongxin;YIN Guoyong(Department of Orthopedics,the First Affiliated Hospital of Nanjing Medical University,Nanjing Jiangsu,210000,P.R.China)

机构地区：[1]南京医科大学第一附属医院骨科,南京210000

出　　处：《中国修复重建外科杂志》2021年第10期1311-1317,共7页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的比较经皮椎弓根螺钉固定结合不同经伤椎椎体内植骨治疗单节段胸腰椎骨折的早期临床疗效。方法回顾性分析2018年10月—2019年10月,行经皮椎弓根螺钉固定结合不同经伤椎椎体内植骨的94例单节段胸腰椎骨折患者临床资料。根据伤椎椎体内植骨方式不同,分为A组(Jack椎体扩张器植骨,40例)和B组(植骨漏斗植骨,54例)。两组患者性别、年龄、身体质量指数、致伤原因、累及节段、Wolter指数、受伤至手术时间及术前疼痛视觉模拟评分(VAS)、伤椎高度比及伤椎Cobb角比较,差异均无统计学意义(P>0.05)。记录并比较两组手术时间、透视次数、植骨量和并发症发生情况。分别于术前,术后3 d、3个月、12个月和末次随访时,采用腰背痛VAS评分评估临床症状缓解情况;分别于术前,术后3 d、3个月及12个月测量伤椎高度比及伤椎Cobb角。结果 A组手术时间、透视次数及植骨量均明显多于B组(P<0.05)。所有患者术后均未出现内固定物松动或断裂等并发症,末次随访时伤椎内植骨均达骨性愈合。术后各时间点腰背痛VAS评分、伤椎高度比及Cobb角均较术前显著改善(P<0.05);与术后3 d比较,术后3个月后VAS评分进一步改善,但伤椎高度比有所下降、Cobb角有所增大,差异均有统计学意义(P<0.05)。术后各时间点两组间腰背痛VAS评分比较差异均无统计学意义(P>0.05);A组伤椎高度比显著高于B组,Cobb角显著低于B组,差异均有统计学意义(P<0.05)。结论与植骨漏斗植骨相比,采用Jack椎体扩张器进行经伤椎椎体内植骨可以明显恢复伤椎高度并减小Cobb角,但透视次数较多、手术时间较长。对于单节段胸腰椎骨折患者,可优先选择使用Jack椎体扩张器行经伤椎椎体内植骨。Objective To investigate the short-term effectiveness of percutaneous pedicle fixation combined with intravertebral allograft by different methods for thoracolumbar fractures. Methods The clinical data of 94 patients with single segment thoracolumbar fracture who underwent percutaneous pedicle fixation combined with intravertebral allograft by different methods between October 2018 and October 2019 were retrospectively analyzed. According to the different methods of intravertebral allograft, they were divided into group A(bone grafting by Jack dilator, 40 cases) and group B(bone grafting by funnel, 54 cases). There was no significant difference between the two groups(P>0.05) in the gender, age, body mass index, cause of injury, injured segment, Wolter index, time from injury to operation, and preoperative visual analogue scale(VAS) score, injured vertebral height ratio, and Cobb angle. The operation time,fluoroscopy frequency, allograft volume, and complications were recorded and compared between the two groups. VAS score of low back pain was used to evaluate the remission of clinical symptoms before operation, at 3 days, 3 months, 12 months after operation, and at last follow-up. The injured vertebral height ratio and Cobb angle were measured before operation, at 3 days, 3 months, and 12 months after operation. Results The operation time, fluoroscopy frequency, and allograft volume in group A were significantly higher than those in group B(P<0.05). No complication occurred after operation, such as loosening or fracture of internal fixation. And bone grafting in the injured vertebrae healed at last follow-up. The VAS score, injured vertebral height ratio, and Cobb angle at each postoperative time point significantly improved when compared with preoperative ones(P<0.05);compared with 3 days postoperatively, the VAS score improved further after 3 months, but the injured vertebral height ratio decreased and the Cobb angle increased, and the differences were significant(P<0.05). There was no significant difference in

关 键 词：胸腰椎骨折 椎体内植骨 Jack椎体扩张器 植骨漏斗 

分 类 号：R687.3[医药卫生—骨科学]