摘要
[目的]探讨经伤椎椎弓根椎体内植骨联合伤椎置钉短节段固定治疗胸腰椎骨折的临床疗效。[方法]收集近年来本院收治的胸腰椎骨折患者68例。将患者随机分为伤椎组与跨伤椎组,每组34例,其中伤椎组患者采用同种异体骨结合自体骨经伤椎椎弓根椎体内植骨联合伤椎置钉短节段固定治疗,跨伤椎组患者采取同种异体骨结合自体骨植骨联合传统跨伤椎短节段固定治疗。对比分析两组患者手术治疗前后的VAS疼痛评分、伤椎前移复位程度、Cobb角、伤椎前后缘高度、脊髓神经功能分级以及并发症等情况。[结果]手术后两组患者的VAS评分均随时间逐渐减少,且各时间点伤椎组患者的VAS评分均低于跨伤椎组(P<0.05),伤椎组患者的脊髓神经功能分级情况明显优于跨伤椎组患者(P<0.05);治疗后两组患者的伤椎前后缘高度均较治疗前有明显改善,但伤椎组患者的改善程度更为明显(P<0.05);术后1个月、6个月和12个月,伤椎组患者的Cobb角明显小于跨伤椎组(P<0.05)。伤椎组患者椎体内出现吸收现象及空洞形成的例数以及矫正度丢失的例数明显少于跨伤椎组(P<0.05)。[结论]经伤椎椎弓根椎体内植骨联合伤椎置钉短节段固定治疗胸腰椎骨折的疗效满意,较常规跨伤椎节段钉棒固定更有利于伤椎的复位和愈合,显著缓解疼痛及改善神经功能,能够较好的维持矫正效果。
[Objective] To evaluate the clinical outcome of thoracolumbar fractures treated by intracorporeal allogeneic plus autotogous bone grafting combined with pedicle screw placed through the pedicle of injured vertebrae and short-segment fixation. [Methods] In recent years, 68 patients with thoracolumbar fractures were randomly divided into two groups in our hos- pital, the via-injured group and the crossover-injured group, with 34 patents in each group. The patients in the former （the viainjured） group had intracorporeal allogeneic plus autologous bone grafting through the pedicles of the injured vertebrae, concurrently with pedicle screws placement on the involved pedicles and short-segment fixation, whereas the patients in the latter （the crossover-injured） group received the conventional pedicle screw-rod fixation combined fusion with allo-geneic plus autologous bone cross over the injured segment. The visual analogue scale （VAS）, American Spinal Injury Associa- tion （ASIA） impairment scale and complication, additionally image measurements, such as Cobb angle and anteroposterior verte- bral body height were used for evaluation of the outcomes. [Results] As time elapsed, the VAS in both groups decreased gradual- ly, however, the via-injured group got statistically lower VAS at any time point postoperatively than the crossover-injured group （P〈0.05）. In addition, the ASIA spinal cord function grades in the via-injured group were significantly better than the cross- over-injured group （P〈0.05）. After operation the height of the anterior and posterior vertebral body margin in both groups was significantly improved compared with those before operation （P 〈0.05）, however, significantly better improvement was noted in the via-injured group （P〈0.05） . The via-injured group was proved significantly less Cobb angle than the crossover injured group at 1, 6 and 12 months postoperatively （P〈0.05）. Furthermore, statistically less incidence of the vertebral body resorption and cavita
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2018年第4期304-309,共6页
Orthopedic Journal of China
基金
贵州省科技厅科学技术基金课题(黔科合J字[2010]2179号)
关键词
胸腰椎骨折
伤椎置钉短节段固定
经伤椎椎体内植骨
同种异体骨移植
thoracolumbar fractures, pedicle screw inserted on the injured vertebrae with short-segment fixation, in- tracorporeal bone grafting on the injured vertebrae, allogeneic bone grafting
