摘要
背景:短节段椎弓根钉系统置入内固定是治疗脊柱胸腰段爆裂骨折的重要方法之一。但由于椎体复位过程中,形成了椎体内空隙即蛋壳样椎体,使前中柱丧失了结构上的完整性,如不进行有效的植骨重建,则有可能出现内固定物失效及矫正度丢失等并发症。目的:探讨短节段椎弓根钉置入复位固定结合自体颗粒骨椎体成形治疗胸腰椎爆裂骨折的方法及临床效果。方法:采用椎弓根钉棒系统对伤椎进行置入复位后,经过伤椎椎弓根植入自体颗粒骨治疗胸腰椎爆裂骨折33例,治疗前后行X射线摄片观察骨折椎体前后缘及椎体中央高度压缩率变化,Cobb角改善情况及并发症发生情况。结果与结论:置入后末次随访测得椎体前后缘、中央高度压缩率及Cobb角,与术前相比差异均明显降低(P<0.05);而与术后即刻相比差异无显著性意义(P>0.05)。29例脊髓神经不完全损伤患者,按美国脊髓损伤协会标准评定,置入后神经功能均有(≥1级)恢复,伤椎椎体高度恢复并维持良好,无植骨操作引起的神经血管并发症。结果说明采用椎弓根螺钉系统复位内固定结合自体颗粒骨椎体成形治疗胸腰椎爆裂骨折,能恢复椎体高度及强度,改善椎体经终板塌陷的复位效果,减少置入后矫正丢失并提高脊柱的稳定性。
BACKGROUND： Short-segment transpedicular screw internal fixation is one of the important methods in treating thoracolumbar burst fracture. However, the formation ofintravertebral void during vertebrae reduction and lost of structure integrality of anterior and middle columns lead to fixation failure or correction loss if no effective bone grafting.
OBJECTIVE： To study the methods and long term results of transpedicular screw internal fixation combined with vertebral plasty of pellet autos bones in treatment of thoracolumbar spine fracture.
METHODS： Thirty-three patients with thoracolumbar spine fracture were treated with short-segmental transpedicalar screw internal fixation combined with vertebral plasty of pellet autos bones. X-ray examinations were done preoperatively. The change of compressed ratios of the anterior and posterior edges of vertebral body and the middle heights of the injured vertebra, as well as the improved Cobb angle were observed respectively.
RESULTS AND CONCLUSION： The mean value of anterior compressed ratios, middle heights compressed ratios and Cobb angle were obviously decreased postoperatively than that of preoperatively （P〈0.05）, which had no statistical significance compared with immediately after operation （P〉0.05）. According to standard of American Spinal Cord Injury Association, the nerve function of 29 cases with incomplete spinal cord injuries reached grade 1 recovery after operation. Related complications were found in all patients. The results demonstrated that transpedicular screw internal fixation combined with vertebral plasty of pellet autos bones can restore the height and strength of vertebral body, improve the reduction effect of vertebral endplate, decrease correction loss, as well as elevate spinal stability.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2010年第26期4911-4914,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
基金
国家自然基金项目(30973025)~~
