摘要
背景:胸腰椎骨折经后路撑开复位后,椎体高度可以得到恢复,但椎体内会形成空腔。目的:探讨同种异体骨椎体内植骨治疗胸腰椎骨折的疗效及并发症。方法:2011年3月至2014年3月725例胸腰椎爆裂骨折患者采取后路椎弓根钉棒系统撑开复位,椎板间开窗,经伤椎椎体后缘骨折线椎体内植骨方法治疗,植骨材料选用同种异体骨颗粒。男473例,女252例;年龄14~57岁,平均33.27岁。神经功能分级采用美国脊柱损伤协会(ASIA)分级评估。CT扫描了解异体骨在椎体内分布情况。根据骨折愈合情况,术后12~24个月取出内固定,取出内固定后3个月摄腰椎X线片了解脊柱后凸Cobb角变化。结果:手术时间90~180 min,平均120 min。术中出血200~500 ml,平均300 ml。植骨量3~9 g。7例患者手术切口感染渗液,经换药后愈合。所有患者随访24~48个月,平均36个月。56例ASIA分级为A级的患者无改善,余患者均获1~2级恢复。损伤节段后凸平均Cobb角由术前32.9°恢复至术后11.1°。伤椎椎体前缘高度由术前平均压缩剩余高度42.6%恢复至术后9.2%。伤椎椎体后缘平均高度由术前压缩27.5%恢复至术后10.9%。椎管前后径残留程度由术前平均45%恢复至术后15.6%。术后6个月椎体内同种异体骨有吸收现象,术后12个月56%患者椎体内有空洞形成,21例螺钉断裂。在内固定取出后3个月,Cobb角增至14.1°,伤椎椎体前缘平均高度压缩至12.6%,后缘平均高度压缩至13.2%。结论:同种异体骨椎体内植骨联合后路椎弓根螺钉内固定治疗胸腰椎骨折的早期疗效满意,后期易出现植骨吸收、空洞形成及矫正度丢失现象。
Background：The height of the involved vertebral body can be restored after the reduction in the thoracolumbar fractures, but the cavity might be formed. Objective：To explore the effectiveness and complications in the treatment of thoracolumbar fractures by allogeneic bone grafting. Methods：A total of 725 patients with thoracolumbar fractures of Dennis B were treated by posterior fixation, laminotomy decompression and intervertebral bone graft in the injured vertebrae between March 2011 and March 2014. There were 473 males and 252 females with a mean age of 33.27 years old （ranged from 14 to 57 years old）. The neurological classification of spinal cord injury was assessed by the American Spinal Injury Association （ASIA） system. The distribution of allogeneic bone grafs were checked by CT scan. The fixators were taken out12-24 months after surgery. Cobb angles were measured on the X-ray films 3 months after removal of the fixators. Results：The mean operation time was 120 min （range, 90-180min）. The mean intraoperative blood loss was 300 ml （range, 200-500ml）. The amount of allogeneic bone grafts used was 3 g to 9 g. Incision infection was found in 7 patients, which was healed after dressing. All the patients were followed up for 24-48 months （mean, 36 months）. Nerve injury was relieved in all patients except for the 56 patients with grade A injury. Compared with preoperative ones, the Cobb angle, anterior and posterior edge height of vertebral body, and residual degree of spinal canal diameter were decreased （32.9° vs 11.1°, 42.6%vs 9.2%, 27.5%vs 10.9%, 45%vs 15.6%）. All the fractures got union within 6 months after operation. Bone absorption was found in 56%of the injured vertebrae 12 months after operation, and screw loosening or rupture was seen in 21 patients. The Cobb angle, anterior and posterior edge height of vertebral body were 11.4°, 12.6%and 13.2%3 months after removal of the fixators. Conclusions：The early curative effect of thoracolumbar fractures with allograft bone graft and pedicle screw fixation are satis-fied, however, bone resorption, porosis and correction loss may occur.
出处
《中国骨与关节外科》
2017年第2期113-116,共4页
Chinese Journal of Bone and Joint Surgery
关键词
胸腰椎骨折
同种异体骨植骨
吸收
空洞
Thoracolumbar Fractures
Allogeneic Bone Grafting
Bone Absorption
Porosis
作者简介
通信作者：于国胜，E-mail：yuguosheng197443@163．com
