陈农;周海林;周凯华;高如峰;刘佐庆;

• 1:复旦大学附属中山医院青浦分院骨科

摘要(Abstract)：

[目的]探讨伤椎固定及经伤椎椎弓根椎体内植骨治疗胸腰段骨折的临床疗效。[方法]2011年12月~2013年12月收治胸腰椎骨折患者共50例,随机分为两组:治疗组行短节段结合伤椎固定及椎体内植骨共25例,对照组行短节段固定共25例,比较两组手术时间、出血量、视觉疼痛程度(VAS)、伤椎前缘高度比值、Cobb角、神经功能恢复(Frankel分级)及并发症情况。[结果]术后所有患者随访6~20个月,平均11.5个月。两组手术时间比较差异有统计学意义(P<0.05),而术中出血量差异无统计学意义(P>0.05);两组患者术后3 d和末次随访VAS评分与术前相比差异有统计学意义(P<0.05),末次随访VAS评分治疗组优于对照组,两组比较差异有统计学意义(P<0.05)。术后3 d和末次随访Cobb角、伤椎前缘高度比值与术前比较均有明显改善(P<0.05),末次随访治疗组伤椎前缘高度比值和Cobb角矫正均优于对照组,两组比较差异具有统计学意义(P<0.05)。两组术后Frankel分级改善无明显差异。末次随访时治疗组无内固定松动、断裂和脱出;对照组中出现螺钉折弯和螺钉断裂各1例。[结论]伤椎固定及经伤椎椎弓根椎体内植骨治疗胸腰段骨折较传统短节段固定方法可更好地重建椎体高度、矫正后凸畸形和维持矫正效果,该手术方法安全而有效。

关键词(KeyWords)： 胸腰椎骨折;伤椎固定;植骨

Abstract:

Keywords:

基金项目(Foundation): 上海市卫生局资助项目(编号:20124304);; 复旦大学附属中山医院青浦分院项目(编号:QYM2012-12);; 上海市医学重点专科建设资助项目(编号:ZK2012A36);; 上海市青浦区卫生计生系统学科带头人项目(编号:WD2015-08)

作者(Author): 陈农;周海林;周凯华;高如峰;刘佐庆;

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DOI:

参考文献(References)：

• [1]Pellise F,Barastegui D,Hernandez-Fernandez A,et al.Viability and long-term survival of short-segment posterior fixation in thoracolumbar burst fractures[J].Spine J,2014,15(14):253-258.
• [2]Altay M,Ozkurt B,Aktekin CN,et al.Treatment of unstable thoracolumbar junction burst fractures with short-or long-segment posterior fixation in magerl type a fractures[J].Eur Spine J,2007,16(8):1145-1155.
• [3]Langrana NA,Harten RD,Lin DC,et al.Acute thoracolumbar burst fractures:a new view of loading mechanisms[J].Spine(Phila Pa1976),2002,279(5):498-508.
• [4]Weinstein JN,Rydevik BL,Rauschning W.Anatomic and technical considerations of pedicle screw fixation[J].Clin Orthop,1992,284:34-46.
• [5]Dick JC,Jones MP,Zdeblick TA,et al.A biomechanical comparison evaluating the use of intermediate screws and cross-linkage in lumbar pedicle fixation[J].J Spinal Disord,1994,7(5):402-407.
• [6]Anekstein Y,Brosh T,Mirovsky Y.Intermediate screws in short segment pedicular fixation for thoracic and lumbar fractures:a biomechanical study[J].J Spinal Disord Tech,2007,20(1):72-77.
• [7]申海波,张宏志.伤椎置钉短节段固定治疗B型胸腰段骨折分析[J].中国矫形外科杂志,2015,23(16):1521-1523.
• [8]Alanay A,Acaroglu E,Yazici M,et al.Short-segment pedicle instrumentation of thoracolumbar burst fractures:does transpedicular intracorporeal grafting prevent early failure[J].Spine(Phila Pa1976),2001,26(2):213-217.
• [9]Liao JC,Fan KF,Keorochana G,et al.Transpedicular grafting after short-segment pedicle instrumentation for thoracolumbar burst fracture:calcium sulfate cement versus autogenous iliac bone graft[J].Spine(Phila Pa 1976),2010,35(15):1482-1488.
• [10]刘团江,郝定均,王晓东,等.胸腰段骨折椎弓根钉复位固定术后骨缺损的CT研究[J].中国矫形外科杂志,2003,11(10):706-707.
• [11]Lin DS,Guo LX,Ding ZQ,et al Transpedicular intracorporeal hydroxyapatite grafting and pedicle screw fixation via paraspinal approach for thoracolumbar fractures[J].Zhonghua Wai Ke Za Zhi,2011,49(2):125-129.
• [12]宋元进,孙海燕,王谦军,等.后路短节段固定结合伤椎固定经椎弓根植骨治疗胸腰段骨折[J].中国矫形外科杂志,2010,18(2):110-112.
• [13]Toyone T,Tanaka T,Kato D,et al.The treatment of acute thoracolumbar burst fractures with transpedicular intracorporeal hydroxyapatite grafting following indirect reduction and pedicle screw fixation:a prospective study[J].Spine(Phila Pa 1976),2006,31(7):208-214.
• [14]Korovessis P,Repantis T,George P.Treatment of acute thoracolumbar burst fractures with kyphoplasty and short pedicle screw fixation:transpedicular intracorporeal grafting with calcium phosphate:a prospective study[J].Indian J Orthop,2007,41(4):354-361.
• [15]Wang W,Yao N,Song X,et al.External spinal skeletal fixation combination with percutaneous injury vertebra bone grafting in the treatment of thoracolumbar fractures[J].Spine(Phila Pa 1976),2011,36(9):606-611.