短节段椎弓根螺钉复位固定伤椎内植骨治疗Denis B型胸腰椎骨折的影像学观察

Imaging study of short-segment pedicle screw instrumentation and transpedicular interbody bone graft for Denis type B thoracolumbar fractures

中文关键词:  胸椎  腰椎  脊柱骨折  植骨  影像学分析

英文关键词:Thoracic vertebrae  Lumbar vertebrae  Spinal fractures  Bone grafting  Imaging analysis

中文摘要:

  【摘要】 目的：探讨短节段椎弓根螺钉固定辅助椎体内植骨对预防Denis B型胸腰椎骨折术后矫正度丢失及伤椎骨缺损的效果。方法：对2005年5月~2011年12月我科收治的40例Denis B型胸腰椎骨折患者经短节段椎弓根螺钉复位固定术后影像学资料进行分析，根据伤椎内是否植骨分为伤椎内植骨组及未植骨组（各20例），统计两组患者手术前后Cobb角、伤椎前缘高度压缩率、椎间隙高度，术后CT矢状位及横断位上观测伤椎骨缺损程度及位置，并进行统计分析。结果：随访时间植骨组为15~30个月，平均22.3个月；未植骨组为12~30个月，平均19.6个月。两组术后均能有效纠正Cobb角及伤椎前缘高度，两组间差异无统计学意义（P>0.05）。植骨组末次随访时Cobb角丢失4.1°±4.0°，椎体前缘高度压缩率丢失（5.0±3.7）%，伤椎相邻上位椎间隙高度丢失（1.29±1.9）mm；未植骨组末次随访时Cobb角丢失5.6°±3.2°，椎体前缘高度压缩率丢失（5.7±4.5）%，伤椎相邻上位椎间隙高度丢失（1.87±1.1）mm；两组矫正度丢失比较，差异无统计学意义（P>0.05）。植骨组末次随访时CT显示伤椎骨缺损在矢状面上主要位于椎体上1/3中部，在横断面上主要位于前柱的中央前缘部，其椎骨缺损程度为（7.1±4.7）％，与未植骨组的（14.7±7.3）％相比，明显降低（P<0.05）。结论：短节段椎弓根螺钉固定椎体内同种异体骨植入治疗Denis B型胸腰椎爆裂骨折可有效矫正Cobb角及伤椎前缘高度，并能有效降低伤椎骨缺损程度。

英文摘要:

  【Abstract】 Objectives: To investigate the loss of correction and defects repairment in Denis type B thoracolumbar fractures treated by short-segment pedicle screw instrumentation and transpedicular interbody bone graft. Methods: X-ray and CT images of forty patients suffering from Denis type B thoracolumbar fractures from May 2005 to December 2011 were collected. The assessments included sagital Cobb angle, compression rate of anterior vertebral body height, and the height of disk space of preoperation and postoperation, the vertebra defect degrees and sites in sagittal view and cross-section view of latest CT imaging. Results: 20 cases underwent short-segment pedicle screw instrumentation with transpedicular interbody bone graft. The time of follow-up was 15－30 months with an average of 22.3 months. 20 cases underwent only short-segment pedicle screw instrumentation. The time of follow-up was 12－30 months with an average of 19.6 months. Two groups showed good recovery of Cobb angle and anterior vertebral body height, with no significant differences(P>0.05). In bone graft group, the loss of correction was 4.1°±4.0°, the loss of anterior vertebral body height was (5.0±3.7)%, the loss of height at cranial adjacent disc was (1.29±1.9)mm. In none-bone graft group, the loss of correction was 5.6°±3.2°, the loss ofanterior vertebral body height was (5.7±4.5)%, the loss of height at cranial adjacent disc was (1.87±1.1)mm. There was no significant difference in the degree of loss of correction(P>0.05). The defects in sagittal and cross section CT scan in bone graft group mainly existed in one-third of the vertebral superior border. Compared with none-bone graft group, bone graft group had less degree of bone defects(P<0.05). Conclusions: Short-segment pedicle screw instrumentation with allograft graft is effective for Denis type B thoracolumbar fractures, which can effectively correct kyphosis, recover anterior vertebral body height and decrease the degree of bone defect.