使用自制植骨漏斗经伤椎植骨联合经皮椎弓根螺钉内固定术治疗胸腰椎骨折的临床疗效

Clinical efficacy on the treatment of thoracolumbar fracture using a homemade bone graft funnel for injured vertebral bone graft combined with percutaneous pedicle screw internal fixation

中文关键词:  胸椎  腰椎  骨折  骨移植

英文关键词:Thoracic vertebrae  Lumbar vertebrae  Fracture  Bone transplantation

中文摘要:

  【摘要】 目的：探讨使用自制微创经皮植骨漏斗进行伤椎植骨联合经皮椎弓根螺钉内固定术治疗胸腰椎骨折的临床疗效。方法：回顾性分析自2020年1月～2021年6月收治的26例无神经损伤的胸腰椎骨折患者临床资料。男13例，女13例，年龄51.23±9.56岁（33～65岁）；均为单节段损伤，T12 2例，L1 8例，L2 8例，L3 5例，L4 3例。采用跨伤椎经皮椎弓根螺钉复位内固定，再通过自制的微创经皮植骨漏斗进行伤椎内空腔内植骨（自体髂骨）。记录患者手术时间、术中出血量和并发症发生情况，观测患者术前、术后1周及末次随访时疼痛视觉模拟评分（visual analogue score，VAS）、Oswestry功能障碍指数评分（Oswestry disability index，ODI）、伤椎前缘高度压缩比、伤椎中部高度压缩率及矢状面Cobb角情况，并进行统计学分析。结果：所有患者手术顺利完成，随访时间为15.19±2.51个月（12~22个月），手术时间84.62±12.88min，出血量55.58±12.44mL，无伤口感染、脊髓损伤等并发症，1例患者出现1枚椎弓根螺钉尾冒松动脱落。术后1周及末次随访时患者伤椎椎体前缘高度压缩率[（6.89±7.25）%、（10.28±7.50）%]、椎体中部高度压缩率[（7.11±5.75）%、（10.63±6.24）%]、Cobb角（4.38°±7.77°、2.14°±7.78°）、VAS评分（3.35±0.56、1.73±0.45）和ODI[（41.96±3.82%、13.77±2.42）%]较术前明显改善（P<0.05），末次随访时伤椎椎体前缘高度压缩率[（10.28±7.50）%]、椎体中部高度压缩率[（10.63±6.24）%]较术后1周轻度增加，Cobb角（2.14°±7.78°）较术后1周略有下降（P<0.05），末次随访时患者VAS评分（1.73±0.45）和ODI[（13.77±2.42）%]较术后1周好转（P<0.05）。结论：对于无神经损伤的胸腰椎骨折患者，使用自制微创经皮植骨漏斗进行伤椎植骨联合经皮椎弓根螺钉内固定手术治疗可有效恢复椎体高度，矫正后凸畸形。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical efficacy of using a homemade minimally invasive percutaneous bone graft funnel for the treatment of thoracolumbar vertebral fractures with injured vertebral bone graft in combination with percutaneous pedicle screw internal fixation. Methods: Clinical data from 26 patients with thoracolumbar spine fractures without nerve injury admitted and treated between January 2020 and June 2021 were retrospectively analyzed. There were 13 males and 13 females, aged 51.23±9.56 years(33-65 years old). All the patients were single-segment injury, and there were 2 cases of T12, 8 cases of L1, 8 cases of L2, 5 cases of L3, and 3 cases of L4. Internal fixation was performed using percutaneous pedicle screw fixation across the injured vertebrae, followed by internal implantation of autologous iliac bone into the injured vertebrae via a homemade minimally invasive bone graft funnel. The operative time, intraoperative bleeding and complications were recorded; The visual analogue scale(VAS) of pain, Oswestry disability index(ODI), compression ratios of the anterior and middle heights of the injured vertebrae, and sagittal Cobb angle were observed and statistically analyzed before operation and at 1 week after operation and final follow-up. Results: All the patients were successfully operated with a follow-up of 12-22 months(15.19±2.51 months). The operative time was 84.62±12.88min, blood loss was 55.58±12.44mL. There were no complications such as wound infection and spinal cord injury, and one patient presented with caudal adventitial loosening of a screwed pedicle. Compared with the preoperative period, the postoperative 1 week and final follow-up anterior height compression rate[(6.89±7.25)%, (10.28±7.50)%] and mid-height compression rate[(7.11±5.75)%, (10.63±6.24)%] of the injured vertebrae, Cobb angle(4.38°±7.77°, 2.14°±7.78°), VAS score(3.35±0.56, 1.73±0.45) and ODI [(41.96±3.82)%, (13.77±2.42)%] were significantly improved(P<0.05). Compared with 1 week postoperatively, at the final follow-up, the patients had a slight increase in the compression rate of the anterior[(10.28±7.50)%] and middle[(10.63±6.24)%] heights of the injured vertebral body, a slight decrease in the Cobb angle(2.14°±7.78°) and a significant improvement in VAS scores(1.73±0.45) and ODI[(13.77±2.42)%](P<0.05). Conclusions: For patients with thoracolumbar fractures without nerve injury, using a homemade minimally invasive bone graft funnel for transforaminal bone grafting in combination with percutaneous pedicle screws can effectively restore the vertebral body height and correct the kyphosis deformity.