短节段椎弓根钉固定联合重组人BMP-2和同种异体骨植骨治疗胸腰椎爆裂骨折

发布时间：2018-03-23 11:43

本文选题：胸腰椎爆裂骨折　切入点：同种异体骨　出处：《中国修复重建外科杂志》2017年09期

【摘要】：目的探讨短节段椎弓根钉固定联合椎体内重组人BMP-2(recombinant human BMP-2,rh BMP-2)和同种异体骨植骨对预防胸腰椎爆裂骨折术后伤椎骨缺损及矫正度丢失的效果。方法将2013年6月—2015年6月收治并符合选择标准的48例胸腰椎爆裂骨折患者随机分为两组,每组24例,分别采用短节段椎弓根钉固定结合伤椎内同种异体骨植骨(对照组)或rh BMP-2和同种异体骨植骨(干预组)治疗。两组患者性别、年龄、致伤原因、损伤节段、椎体压缩程度、胸腰椎损伤分类及损伤程度(TLICS)评分、神经症状Frankel分级及术前Cobb角、伤椎前缘高度压缩率等一般资料比较,差异均无统计学意义(P0.05),具有可比性。于术后1周及末次随访时测量两组患者Cobb角及伤椎前缘高度压缩率,并计算末次随访时内固定相邻上、下位以及伤椎相邻上、下位椎间隙高度改变和伤椎骨缺损程度。结果两组患者均获随访,随访时间21~45个月,平均31.3个月。两组骨折均愈合,干预组和对照组愈合时间分别为(7.6±0.8)、(7.5±0.8)个月,比较差异无统计学意义(t=0.336,P=0.740)。末次随访时两组神经功能Frankel分级均达E级。术后1周及末次随访时两组Cobb角及伤椎前缘高度压缩率均较术前显著改善(P0.05)。术后1周两组Cobb角及伤椎前缘高度压缩率比较,差异均无统计学意义(P0.05);但末次随访时干预组上述指标均优于对照组(P0.05)。末次随访时,两组内固定相邻上、下位以及伤椎相邻上、下位椎间隙高度改变比较,差异均无统计学意义(P0.05)。对照组患者术后椎体骨缺损发生率为75.0%(18/24),干预组为20.8%(5/24),两组比较差异有统计学意义(χ2=14.108,P=0.000)。发生椎体骨缺损患者中,对照组骨缺损程度为7.50%±3.61%,干预组为2.70%±0.66%,差异有统计学意义(t=6.026,P=0.000)。结论短节段椎弓根钉固定联合椎体内同种异体骨和rh BMP-2打压植骨,可有效维持伤椎高度及降低伤椎骨缺损程度。
[Abstract]:Objective to investigate the effect of short segment pedicle screw fixation combined with recombinant human BMP-2(recombinant human BMP-2rh BMP-2) and allograft bone graft on the prevention of vertebral defect and loss of correction after thoracolumbar burst fracture. A total of 48 patients with thoracolumbar burst fracture were randomly divided into two groups. 24 cases in each group were treated with short segment pedicle screw fixation combined with allograft bone graft (control group) or Rh BMP-2 or allograft bone graft (intervention group). The general data of compression degree of vertebral body, classification of thoracolumbar vertebrae injury and TLICS score, Frankel grade of nerve symptom and Cobb angle before operation, compression ratio of anterior edge of injured vertebrae were compared. At 1 week and the last follow-up, the Cobb angle and the high compression ratio of the injured vertebra were measured, and the adjacent upper, lower and injured vertebrae adjacent to the upper, lower and injured vertebrae were calculated at the last follow-up. Results the two groups were followed up for 21 ~ 45 months (mean 31.3 months). The healing time of fracture was 7.6 卤0.8 卤0.8 months in the intervention group and 7.5 卤0.8 months in the control group, respectively. There was no statistical difference between the two groups. At the last follow-up, the Frankel grade of nerve function in both groups reached E grade. The Cobb angle and the high compression ratio of the anterior edge of the injured vertebrae in the two groups were significantly improved 1 week after operation and at the end of the follow-up compared with those before operation (P 0.05) and the Cobb in the two groups was significantly improved at 1 week after operation. Comparison of the compression ratio of angle and anterior edge of injured vertebra, There was no significant difference between the two groups, but at the last follow-up, the above indexes in the intervention group were better than those in the control group (P 0.05). At the last follow-up, the changes of the height of the intervertebral space between the two groups were compared between the two groups. There was no significant difference between the two groups (P 0.05). The incidence of vertebral bone defect was 75.0% in the control group and 20.8% in the intervention group. There was a significant difference between the two groups (蠂 214.108 P 0.000). The degree of bone defect in the control group was 7.50% 卤3.61 and that in the intervention group was 2.70% 卤0.66. The difference was statistically significant. Conclusion short segment pedicle screw fixation combined with allograft and rh BMP-2 can effectively maintain the height of injured vertebra and reduce the degree of injured vertebral bone defect.
【作者单位】：苏州大学附属无锡市骨科医院无锡市第九人民医院骨科;
【分类号】：R687.3

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