胸腰椎爆裂性骨折经椎弓根植骨内固定临床研究  

Clinical Study of Transvertebral Arch Bone Graft Internal Fixation in Thoracolumbar Burst Fracture

作　　者：陈民[1] 陈旭狮 蔡宏华[1] CHEN Min;CHEN Xushi;CAI Honghua(Department of Spine Orthopaedics,Huizhou Central People's Hospital,Huizhou Guangdong 516001,China)

机构地区：[1]广东省惠州市中心人民医院脊柱骨科,广东惠州516001

出　　处：《中国卫生标准管理》2022年第4期74-77,共4页China Health Standard Management

基　　金：惠州市医疗卫生类科技计划项目(2018Y034)。

摘　　要：目的评价经伤椎椎弓根钉固定结合植骨治疗胸腰椎爆裂骨折的临床疗效,影像学改变,探讨其适应证。方法回顾2016年6月—2019年6月,我院收治胸腰椎爆裂骨折患者56例。其中研究组26例胸腰椎爆裂骨折患者实施椎弓根钉内固定、伤椎植骨及置钉。对照组30例胸腰椎爆裂骨折患者实施单纯伤椎椎弓根钉固定。比较两组患者骨折椎体高度及骨折节段后凸角度变化。CT计算病椎骨性愈后椎体空洞大小。同时对临床症状进行评价。结果术后随访(17.3±5.2)个月,研究组椎体内植骨融合良好,术后伤椎前缘平均高度恢复到90%,对照组恢复到93%,两组相比较差异无统计学意义(P>0.05)。研究组术后末次随访脊柱后凸角(Cobb’S角)为(4.8±0.7)°,无断钉及松动,无出现神经症状。对照组末次随访脊柱后凸角(Cobb’S角)为(14.4±2.8)°,与研究组相比差异有统计学意义(P<0.05),有1例断钉,无松动,无出现神经症状。研究组术后末次随访椎体空洞大小为(432.2±80.3)mm^(3),对照组为(1336.5±609.1)mm^(3),两组相比差异有统计学意义(P<0.05)。结论经伤椎椎弓根植骨结合椎弓根钉内固定治疗胸腰椎骨折有良好的复位和固定作用,可有效的消除伤椎的“蛋壳”效应,能即时增加椎体的骨容量和脊柱前柱的抗压稳定性。短期效果减少椎体高度丢失,长期对骨质疏松严重患者效果满意,值得推荐。Objective To evaluate the clinical efficacy,imaging changes and indications of the treatment of thoracolumbar burst fractures by pedicle screw fixation and pedicle bone grafting of the injured vertebrae.Methods A total of 56 patients with thoracolumbar burst fractures admitted to our hospital from June 2016 to June 2019 were retrospectively reviewed.In the study group,26 patients with thoracolumbar burst fractures were treated with transpedicle screw fixation combined with transpedicle vertebral body bone graft.In the control group,30 patients with thoracolumbar burst fracture were treated with pedicle screw fixation.The height of fracture vertebral body and the kyphosis Angle of fracture segment were compared between the two groups.CT was used to calculate the size of the vertebra cavity.Meanwhile,the clinical symptoms were evaluated.Results The postoperative follow-up was(17.3±5.2)months.The vertebral fusion was good in the study group,and the average height of the anterior edge of the injured vertebra was restored to 90%and 93%in the control group.There was no statistical significance between the two groups(P>0.05).In the study group,the Cobb's Angle was(4.8±0.7)°at the last follow-up after surgery,and no screws were broken or loosened,and no neurological symptoms were observed.Cobb's Angle was(14.4±2.8)°in the control group at the last follow-up,which was statistically significant compared with the study group(P<0.05).There was 1 case of screw fracture,no loosening,and no neurological symptoms.The size of vertebral cavity was(432.2±80.3)mm^(3) in the study group and(1336.5±609.1)mm^(3) in the control group at the last postoperative follow-up,which was statistically significant(P<0.05).Conclusion The combination of pedicle screw internal fixation and pedicle bone graft in the treatment of thoracolumbar fracture has a good reduction and fixation effect,which can effectively eliminate the"eggshell"effect of the injured vertebrae,and can immediately increase the vertebral body bone capacity and the compres

关 键 词：胸腰椎骨折 椎弓根钉 异体骨 经椎弓根椎体内植骨 内固定 爆裂骨折 

分 类 号：R683[医药卫生—骨科学]