经伤椎椎弓根椎体内植骨置钉短节段固定治疗胸腰椎骨折Intracorporeal bone grafting combined with screw inserted through pedicles of injured vertebrae and short-segment fixation for treatment of thoracolumbar fracture
季文军;敖俊;廖文波;王信;孔维军;覃建朴;范红松;张军;
摘要(Abstract):
[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。
关键词(KeyWords): 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
基金项目(Foundation): 贵州省科技厅科学技术基金课题(黔科合J字[2010]2179号)
作者(Author): 季文军;敖俊;廖文波;王信;孔维军;覃建朴;范红松;张军;
Email:
DOI:
参考文献(References):
- [1]Singh R,Rohilla RK,Kamboj K,et al.Outcome of pedicle screw fixation and monosegmental fusion in patients with fresh thoracolumbar fractures[J].Asian Spine J,2014,8(3):298-308.
- [2]Pellise F,Barastegui D,Hernandez-Fernandez A,et al.Viability and long-term survival of short-segment posterior fixation in thora-columbar burst fractures[J].Spine J,2014,15(14):253-258
- [3]陈太勇,龙凌丽,曹广如,等.经椎板间隙开窗伤椎椎体内植骨治疗胸腰椎爆裂骨折[J].中国修复重建外科杂志,2014,28(10):1236-1238.
- [4]常锐,王德春.三种伤椎置钉固定胸腰椎爆裂骨折的疗效对比[J].中国矫形外科杂志,2017,25(6):521-526.
- [5]陈林,覃建朴,伍富俊,等.微创通道下开窗减压椎体内植骨经皮椎弓根螺钉内固定治疗Denis B型胸腰椎爆裂骨折[J].中国修复重建外科杂志,2016,8(30):427-429.
- [6]于国胜,赵秀泉,刘颜华,等.同种异体骨椎体内植骨治疗胸腰椎骨折吸收及空洞形成报告[J].中华骨与关节外科杂志2017,10(2):113-116.
- [7]Xu Z,Hao D,He L,et al.An assessment system for evaluating the severity of thoracolumbar osteoporotic fracture and its clinical application:a retrospective study of 381 cases[J].Clin Neurol Neurosurg,2015,139(1):70-75.
- [8]Mc Comack T,Karaikovic E,Gaines RW.The road sharing classification of spine fractures[J].Spine,1994,19(15):1741-1744.
- [9]Denis F.The three column spine and its significance in the classification of acute thoracolumbar spinal injuries[J].Spine(Phila Pa1976),1983,8(8):817-831.
- [10]Bu BX,Wang MJ,Liu WF,et al.Short-segment posterior instrumentation combined with calcium sulfate cement vertebroplasty for thoracolumbar compression fractures:radiographic outcomes including nonunion and other complications[J].Orthop Traumatol Surg Res,2015,101(2):227-233.
- [11]陈农,周海林,周凯华,等.伤椎固定及经伤椎椎弓根椎体内植骨治疗胸腰段骨折[J].中国矫形外科杂志,2016,24(6):525-530.
- [12]Kose KC,Inanmaz ME,Isik C,et al.Short segment pedicle screw instrumentation with an index level screw and cantilevered hyperlordotic reduction in the treatment of type-A fractures of the thoracolumbar spine[J].Bone Joint J,2014,96-B(4):541-547.
- [13]李想,洪毅,张军卫,等.侧入路微创椎间融合结合后路短节段固定治疗胸腰段骨折的初步临床疗效[J].中国脊柱脊髓杂志,2014,24(5):400-406.
- [14]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.
- [15]Chen C,Lv G,Xu B,et al.Posterior short-segment instrumentation and limited segmental decompression supplemented with vertebroplasty with calcium sulphate and intermediate screws for thoracolumbar burst fractures[J].Eur Spine J,2014,23(7):1548-1557.