摘要
目的观察采用伤椎内植骨成形联合后路植骨椎弓根螺钉复位固定治疗重度胸腰椎爆裂性骨折的临床疗效。方法 2007年10月至2013年5月该科采用经伤椎两侧椎弓根建立工作通道,把自体骨和同种异体骨粉碎成颗粒状植入伤椎椎体内,伤椎椎体成形。同时联合后外侧植骨,后路短节段钉棒系统复位固定治疗重度胸腰椎爆裂性骨折36例患者。伴有骨质疏松者予以骨水泥强化固定椎弓根螺钉。观察术前、术后、术后3、6个月、术后1年及最后1次随访时的临床表现及影像学资料。观察椎体内植骨及后路融合情况,测量椎管狭窄率、椎体后凸角(Cobb角)及伤椎前缘压缩率,评估腰痛程度和神经功能恢复情况。结果 36例患者均获得随访,随访时间13个月至5年,平均3年2个月。术后椎管狭窄率[(3.4±1.2)%]、Cobb角[(5.2±3.1)°]及伤椎前缘压缩率[(4.4±3.1)%]较术前[(67±10.6)%、(38±4.5)°、(43.2±21.7)%]均有显著改善,差异均有统计学意义(P<0.01),而与最后1次随访结果比较,差异均无统计学意义(P>0.05)。CT及X射线检查显示术后伤椎内植入骨充填良好,无伤椎"空壳"现象,复位的椎体高度无明显丢失,平均愈合时间3.5个月,后路植骨融合平均5.0个月,无假关节形成。无一例发生内固定失败。术前伴有神经损伤患者均有一定程度的改善。结论重度胸腰椎爆裂性骨折采用伤椎内植骨成形联合后路植骨椎弓根螺钉复位固定技术解决伤椎前、中柱骨缺损、骨量不足的问题,同时又增强了伤椎与临椎后柱的融合、固定。3柱的修复与稳定,有效地避免了远期内固定失败、伤椎高度再丢失带来的一系列并发症,临床疗效好,是一种可靠的治疗方法。
Objective To evaluate the clinical effect of serious thoracolumbar vertebral burst fractures treated by transpedicular bone graft and posterior fixation with pedicle screws system and posterolateral bone graft. Methods A total of 36 patients with serious thoracolumbar burst fractures from Oct 2007 to May 2013 were treated by transpedicular bone graft with au-tologous and allogeneic bone chips combined with posterior fixation with pedicle screws system and posterolateral bone graft. For osteoporosis patients,bone cement was applied to reinforce screw fixation. The clinical outcome and imaging examination results before surgery,at the 3rd,6th,12 th month after surgery and at the last follow up were studied. The condition of the bone graft and posterior cervical fusion was evaluated. The canalis vertebralis stenosis,the Cobb′ s angle and vertebral compression ratio were measured. The lumbago degree and neural functional recovery were assessed. Results All the patients were followed up to 3years and 2 months in average（ranged from 13 months to 5 years）. The canalis vertebralis stenosis,the Cobb′s angle and vertebral compression ratio[（3.4±1.2）%,（5.2±3.1）°,（4.4±3.1）%] were all significantly improved immediately after surgery with statistically significant difference（P〈0.01）,and there was no significant difference considering these parameters between immediately after surgery and at the last follow up（P〉0.05）. CT and X ray results showed the stable bone graft,no ＂shell＂ phenomenon,no vertebral body height lost,and an average healing time of 3.5 months. The average healing time for posterior cervical fusion was 5.0 months,and pseudarthrosis formation was not observed. Fixation failure did not occur in any of the studied cases. Nerve injuries were all improved to a certain degree after surgery. Conclusion Transpedicular bone graft combined with posterior fixation with pedicle screws system and posterolateral bone graft can solve the problem of bone defect of anterior and middle column in serious thora-columbar burst fractures,and in addition,it can reinforce the fusion and fixation between the fracture vertebra and the adjacent vertebra. The repaired and stable structure of three-column can effectively avoid the long term complications due to fixation failure and vertebral body height lost. The studied surgery procedure is reliable in the treatment of serious thoracolumbar burst fractures.
出处
《现代医药卫生》
2014年第24期3702-3704,3706,共4页
Journal of Modern Medicine & Health
关键词
骨折
骨折固定术
腰椎
骨质疏松
手术候期间
Fractures
Fracute fixation
Lumbar vertebrae
Osteoporosis
Postoperative period
作者简介
丁建忠（1969-），男，江苏宿迁人，副主任医师，主要从事脊柱外科、创伤骨科临床工作；E—mail：sqdingjz@126．com。
