【摘要】：目的探討經(jīng)椎板間隙小開窗與經(jīng)椎弓根椎體內植骨治療Denis A、B型胸腰椎爆裂型骨折的重建效果和遠期穩(wěn)定性差異。方法回顧分析2012年1月—2014年2月,采用椎體內植骨成形聯(lián)合椎弓根釘棒系統(tǒng)內固定術治療的50例Denis A、B型胸腰椎爆裂型骨折患者的臨床資料。其中,30例術中采用經(jīng)傷椎椎板間隙小開窗椎體內植骨(A組),20例采用經(jīng)傷椎單側椎弓根椎體內植骨(B組)。兩組患者除術前Cobb角比較,差異有統(tǒng)計學意義(P0.05)外,性別、年齡、致傷原因、傷后至手術時間、骨折分型、損傷節(jié)段以及術前神經(jīng)功能Frankel分級、傷椎前緣高度百分比、疼痛視覺模擬評分(VAS)等一般資料比較,差異均無統(tǒng)計學意義(P0.05)。記錄并比較兩組患者后凸Cobb角、傷椎前緣高度百分比及腰背部疼痛、神經(jīng)功能恢復情況。結果兩組患者均獲隨訪,A組隨訪時間16~31個月,平均19.1個月;B組17~25個月,平均20.2個月。兩組術后切口均Ⅰ期愈合,無神經(jīng)損傷等手術相關并發(fā)癥發(fā)生。兩組術前存在神經(jīng)功能損傷患者,除Frankel A級患者外,其余患者神經(jīng)功能均有不同程度改善。兩組患者腰背部疼痛均較術前緩解,術后3個月、末次隨訪時VAS評分與術前比較,差異均有統(tǒng)計學意義(P0.05);兩組間術后各時間點間比較,差異無統(tǒng)計學意義(P0.05)。X線片復查示,隨訪期間兩組均未發(fā)生斷釘、退釘、斷棒、內固定松動等;傷椎椎體內植骨填充良好,植骨融合。術后傷椎椎體高度均恢復良好,A、B組術后1周、3個月及末次隨訪時傷椎前緣高度百分比及后凸Cobb角與術前比較,差異有統(tǒng)計學意義(P0.05);術后各時間點間比較,差異均無統(tǒng)計學意義(P0.05)。兩組間術后各時間點以上兩指標比較,差異均無統(tǒng)計學意義(P0.05)。結論對于Denis A、B型胸腰椎爆裂型骨折,經(jīng)椎板間隙小開窗或經(jīng)椎弓根進行椎體內植骨聯(lián)合椎弓根釘棒系統(tǒng)內固定術治療均能較好恢復椎體高度和矯正后凸并維持椎體穩(wěn)定,降低了內固定物松動、斷裂等并發(fā)癥發(fā)生風險。因此,可根據(jù)患者椎管占位嚴重程度、椎體塌陷情況及脊髓神經(jīng)損傷程度,選擇合適植骨通道。
[Abstract]:Objective to investigate the difference of reconstruction effect and long-term stability of Denis A and B thoracolumbar burst fractures treated by small fenestration through laminar space and bone graft through pedicle vertebra in the treatment of thoracolumbar burst fracture. Methods from January 2012 to February 2014, the clinical data of 50 patients with thoracolumbar burst fracture (Denis A, B) treated with vertebroplasty and pedicle screw fixation were retrospectively analyzed. Among them, 30 cases were treated with bone graft through small window of laminar space (group A), and 20 cases were treated with bone grafting through unilateral pedicle vertebra of injured vertebra (group B), among which 30 cases were treated with bone graft through the small fenestrated space of vertebral lamina (group A). The difference of Cobb angle before operation between the two groups was statistically significant (P0.05), gender, age, cause of injury, time from injury to operation, fracture classification, Frankel grade of injured segment and preoperative nerve function, percentage of anterior edge height of injured vertebra. There was no significant difference in pain visual analogue score (VAS) and other general data (P0.05). The Cobb angle of kyphosis, the percentage of anterior edge height of injured vertebrae, the pain of waist and back and the recovery of nerve function were recorded and compared between the two groups. Results the patients in both groups were followed up for 16 months 31 months (mean 19.1 months) and group B 17 months 25 months (average 20.2 months). There were no operative complications such as nerve injury and wound healing in both groups. There were patients with neurologic impairment before operation in both groups. Except for Frankel A patients, the neurological function of the other patients were improved to some extent. There was significant difference in VAS scores between the two groups at the last follow-up 3 months after the operation (P0.05). The pain in the back and waist of the two groups were relieved compared with those before the operation (P0.05). There was no significant difference between the two groups at each time point after operation (P0.05). X-ray examination showed that there were no broken nails, screw removal, broken rods and loosening of internal fixation in the two groups during the follow-up period; the injured vertebrae were well filled with bone graft and fused with bone graft. In group A, the percentage of anterior edge height and kyphosis Cobb angle at 1 week, 3 months and last follow-up were significantly different from those before operation (P0.05). There was no significant difference between the time points after operation (P0.05). There was no significant difference between the two groups at each time point after operation (P0.05). Conclusion for Denis A and B thoracolumbar burst fractures, the vertebral body height can be recovered and the kyphosis can be corrected and the stability of the vertebral body can be maintained by internal fixation of vertebral body with bone graft combined with pedicle screw system through the small window of the lamina space or through the pedicle of vertebrae in the treatment of thoracolumbar burst fracture of Denis A and B type. It reduces the risk of complications such as loosening and breaking of the internal fixator. Therefore, appropriate bone graft channels can be selected according to the degree of vertebral canal occupation, vertebral body collapse and spinal cord nerve injury.
【作者單位】： 遵義醫(yī)學院附屬醫(yī)院脊柱外科;
【基金】：貴州省科學技術基金課題資助項目(2010J2179) 遵義醫(yī)學院博士科研啟動基金資助項目(201019)~~
【分類號】：R687.3

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本文編號：2436222