经伤椎椎弓根植骨置钉后路复位内固定术治疗胸腰椎骨折

The treatment of thoracolumbar fractures with posterior transpedicular instrumentation of bone graft and vertebral pedicle screw in fractured vertebra

中文关键词:  胸腰椎骨折  经伤椎固定  伤椎植骨

英文关键词:Thoracolumbar fractures  Injured vertebral fixation  Bone graft in injured vertebra

中文摘要:

  【摘要】 目的：探讨在后路复位内固定术治疗胸腰椎骨折中，经椎弓根伤椎植骨置钉手术的有效性和安全性。方法：选取2007年6月～2009年9月间的胸腰椎单节段骨折患者共75例，30例行经椎弓根伤椎植骨置钉（A组），45例行常规跨伤椎（B组）的后路复位内固定治疗；测量手术前后数字射线摄影（DR）侧位片上的伤椎相邻椎Cobb角、伤椎椎体前缘高度（前高），计算伤椎前高压缩比；测量手术前后CT片上伤椎椎管中矢径和计算椎管侵占率；统计手术时间和术中出血量，观察手术并发症，用Denis疼痛分级评估术后腰痛。结果：伤椎前高压缩比A组术前为59.8%，术后为92.9%；B组术前为57.3%，术后为87.1%。相邻椎Cobb角A组术前为20.2°，术后为8.5°，末次随访时为10.3°；B组术前为22.7°，术后为12.3°，末次随访时为16.7°；椎管侵占率A组术前为37.1%，术后为21.9%；B组术前为34.8%，术后为18.3%；A组平均出血量256ml，手术时间107min，疼痛评估P1 25例，P2 5例，1例脑脊液漏；B组平均出血量236ml，手术时间87min，疼痛评估P1 35例，P2 8例，P3 2例，有1例断钉和2例内固定松动；两组手术时间差异有显著性（P＜0.05）；术后与末次随访时的椎体压缩比和Cobb角两组间比较差异有显著性（P＜0.05），而组内比较A组差异无显著性（P＞0.05），B组差异有显著性（P＜0.05）；在椎管侵占率、手术出血量和并发症以及疼痛评估上，两组比较差异无显著性（P＞0.05）。结论：在后路复位内固定术治疗胸腰椎骨折中，经伤椎椎弓根植骨置钉能更好地矫正后凸畸形、重建椎体高度、维持矫正效果和减少内固定的松动断裂等并发症，手术有效且安全。

英文摘要:

  【Abstract】 Objective：To assess the efficacy and safety of the method in treatment of thoracolumbar fractures with posterior instrumentation of bone graft and vertebral pedicle screw in fractured vertebra.Method：75 cases of single segmental thoracolumbar fracture between June 2007 and September 2009 were treated by posterior reduction and internal fixation，30 cases with bone graft and vertebral pedicle screw in fractured vertebra（group A），45 cases with routine fixation strided over fractured vertebra（group B）.The adjacent vertebral Cobb angle and the anterior height of injured vertebra in lateral radiograph were measured before and after surgery，then the vertebral compression ratio was calculated.The sagittal diameter of injured vertebral spinal canal encroachment on the CT scan was measured before and after surgery，and the occupation ratio was calculated.The operation time and blood loss were recorded，the surgical complications were observed，and the scores of low back pain with Denis′Grading System were got.Result：The anterior high vertebral compression ratio in group A was 59.8% and 92.9%，before and after surgery respectively.In group B，it was 57.3% and 87.1% respectively.The adjacent vertebral average Cobb angle turned from 20.2° preoperatively to 8.5° postoperatively and maintained 10.3° at final follow-up in group A.In group B，it turned from 22.7° preoperatively to 12.3° postoperatively and maintained 16.7° at final follow-up.The spinal canal encroachment ratio turned from 37.1% to 21.9% in group A and turned from 34.8% to 18.3% in group B. The average amount of blood loss in group A was 256ml，with the operation time of 107min；the pain assessment for P1 was in 25 cases，P2 in 5 cases；and there was 1 case of cerebrospinal fluid leakage.The average amount of blood loss in group B was 236ml，with the operation time of 87min；the pain assessment for P1 was in 35 cases，P2 in 8 cases，and P3 in 2 cases；and there was 1 case of screw breakage and 2 cases of loosening of internal fixation.There was a significant difference between two groups in operation time，vertebral compression ratio and Cobb angle（P＜0.05）.The above data showed no significant difference within group A（P＞0.05），but showed statistically significant difference within group B（P＜0.05）.However，there was no significant difference in spinal canal encroachment ratio，surgical bleeding amount，the complications and pain scores between two groups（P＞0.05）.Conclusion：In the treatment of thoracolumbar fractures with posterior reduction and internal fixation，the method of bone graft and vertebral pedicle screw in fractured vertebra obtained better kyphosis correction，reconstructed vertebral body height and maintained the correction effect.It also reduced the incidence of internal fixation hardware failure.This method did not increase the amount of bleeding，the incidence of infection，nerve damage and other complications.It was safe and effective.