前路减压椎间支撑体周围植骨治疗胸腰椎骨折的疗效观察

The feasibility and efficacy of anterior interboby bone graft for thoracolumbar fracture

中文关键词:  胸腰椎骨折  前路手术  支撑体周围植骨

英文关键词:Thoracolumbar burst fracture  Anterior approach  Grafting around the cage

中文摘要:

  【摘要】 目的：探讨胸腰椎骨折前路手术中椎间支撑体周围植骨的有效性和可行性。方法： 2005年5月~2010年5月采用胸腰椎前路减压椎间支撑体周围颗粒状植骨治疗胸腰椎骨折患者167例，术前、术后1周、3个月、6个月、1年行X线片及三维CT薄层扫描，观察支撑体周围颗粒状植骨融合状况，测量伤椎高度、Cobb角、椎管狭窄率。采用改良Brantigan椎间融合标准判定椎间、支撑体植骨融合情况。结果：所有患者均顺利完成手术，116例患者随访1~4.5年，平均2.2年，术后1周X线片未见支撑体明显移位，56例CT平扫支撑体周围无明显血肿形成。术后3个月48例CT薄层扫描支撑体（钛网/人工骨）与周围植骨有1~2mm左右透亮线，椎管内无碎骨块占位。术后6个月X线片未见椎旁异位骨化，41例CT薄层扫描支撑体周围植骨与支撑体及椎间有连续性骨小梁形成，未见植骨块进入椎体旁和椎管内。术后1年植骨融合48例4分，39例3分，29例2分。12例纳米人工骨支撑体与周围植骨之间仅少量连续性骨小梁形成，存在1~2mm间隙，但周围植骨已骨性愈合，对人工骨形成包裹。3例钛网和4例人工骨支撑体倾斜（在矢状面或冠状面倾斜均小于10°），Cobb角13°~16°，高于平均值9.5°。术后1周和1年椎间高度、Cobb角、椎管狭窄率与术前比较均有显著改善，差异有统计学意义（P<0.05），术后1周与1年比较差异均无统计学意义（P>0.05）。结论：胸腰椎骨折前路减压椎间支撑体周围植骨可增加脊柱力学载荷强度，有利于恢复脊柱的稳定性和椎间植骨融合，从而降低内固定物松动和断裂的可能性。

英文摘要:

  【Abstract】 Objectives: To evaluate the feasibility and efficacy of anterior interbody bone graft for the treatment of thoracolumbar burst fracture. Methods: From March 2005 to March 2011，167 patients with thoracolumbar burst fracture were treated with anterior approach. All patients were evaluated using X-ray and 3 dimensional CT scans prior to surgery, 3, 6, 12 months postoperatively and annually thereafter to observe the fusion status and the kyphotsis Cobb angle, the height of fractured vertebrae and spinal stenosis rate. The modified Brantigan grade was used to assess the fusion rate. Results: All patients underwent surgery successfully. 116 patients were followed up for an average of 2.2 years(range, 1-4.5 years). One week after surgery, X-ray revealed no bone graft shifting into the spinal canal. CT scans of 56 patients revealed no obvious hematoma around the cage. In 48 cases, CT scan showed a 1-2mm transparent line between cage and bone graft while no trace of bone fragments in the spinal canal 3 months at surgery. No heterotopic ossification was found by X-ray 6 months after surgery. CT scans revealed continuous trabeculae bone formation between cage and bone graft with no bone fragments in the spinal canal in 41 patients. One year into the follow-up, 48 patients scored 4 points on the modified Brantigan grade, 39 scored 3 points, and 29 scored 2 points. For the 12 cases with nano cages, the cages was partially fused with the surrounding bone graft, leaving a fissure of 1-2mm wide. Cages were found inclined(in the coronal or sagittal plane the inclination were less than 10°) in 7 cases with a Cobb angle between 13° to 16°(more than 9.5°). At last follow-up no obvious side convex or kyphosis was noted, the difference before and after the surgery is significant(P＜0.05). Conclusions: Anterior interbody bone graft for thoracolumbar fracture increases the mechanical strength of spine, improve stability and fusion ratewhile decreases the risk of implant failure.