摘要
目的探讨胸腰椎骨折经后路体位+经椎弓根椎体内撑开复位,结合经椎弓根椎体内植骨内固定的手术方法在术前及术后各随访时间点区域矢状面形态的变化。方法回顾性分析自2010-05—2011-12诊治的胸腰椎骨折45例,其中A组21例采用体位复位、经椎弓根椎体内撑开复位,经椎弓根椎体内植入硫酸钙人工骨,后路钉棒系统内固定。B组24例采用传统后路撑开复位内固定术,不予植骨。测量术前、术后、取内固定前、取内固定后矢状面参数,比较各组内不同随访时间点及相同时间点两组之间的差异。结果末次随访时B组的PIH较术后即时减少0.39 cm(P<0.05),而A组变化差异无统计学意义。末次随访时A、B组IVA分别为-5.26°、-0.32°,与术后即时相比2组分别丢失3.41°和6.32°(P=0.032)。2组DIH术后的变化差异无统计学意义(P>0.05)。AVH和MHV术后均有显著恢复,差异有统计学意义(P<0.05),随访过程中复位高度有所丢失,但差异无统计学意义(P>0.05)。2组AWA和RA术后明显减小,差异有统计学意义(P<0.05),术后随访均有一定程度的后凸增大,但差异无统计学意义(P>0.05)。结论胸腰椎骨折经后路体位+经椎弓根椎体内撑开复位,结合经椎弓根椎体内植骨内固定可以获得良好的椎体复位和高度维持,并且可减轻术后椎间隙高度的丢失,一定程度上阻止后凸畸形的进展。
Objective To analyze the sagittal alignment of thoracolumbar fracture after the reduction of postural and vertebral body distraction combined with bone graft in fractured vertebra, and compared with traditional method. Methods From May 2010 to December 2011, forty-five thoracolumbar fracture patients with posterior short segmental fixation were evaluated in this retrospective study. The patients were divided into two subgroups according to the method of reduction： group A, postural and vertebral body distraction combined with bone graft in fractured vertebra, group B, distraction by pedical screw and rod system without bone graft. Sagittal parameters were measured preoperation and during follow-up. Radiographic parameters were compared between the two groups and within each group during follow-up. Results At final follow-up, PIH showed 0.39 cm height lost compared to postoperative height（P〈 0.05）, while there was no statistical difference in group A. Similarly,at final follow-up, IVA averaged-5.26° in group A and-0.32° in group B（P 〈0.01）, and there was a lordosis loss of 3.41° in group A compared to the 6.32° in group B（P =0.032）. DIH increased slightly after operation, and maintained during follow-up（P〉 0.05）. AVH and MHV got good recovery of height, while there were reduced tendency of AVH and MHV during follow-up（P 〉0.05）. AWA and RA reduced significantly after operation in two groups（P 〈0.05）, which showed slight lordosis loss during follow-up（P 〉0.05）. Conclusion For thoracolumbar fracture patients, satisfactory reduction of fractured vertebra could be achieved and maintained during follow-up with postural and vertebral body distraction combined with bone graft in fractured vertebra. What＇s more, the new method may minimize disc stress, reduce the loss of intervertebral height and prevent the progression of thoracolumbar kyphosis.
出处
《中国骨与关节损伤杂志》
2015年第1期31-34,共4页
Chinese Journal of Bone and Joint Injury
基金
江苏大学临床科技发展基金项目(JLY20120154)
关键词
胸腰椎
骨折
内固定
矢状面
Thoracolumbar
Fracture
Internal fixation
Sagittal
