跨伤椎椎弓根钉内固定合并同种异体骨椎体后外侧植骨修复胸腰椎爆裂性骨折

发布时间：2018-05-12 17:42

本文选题：胸椎 + 腰椎　；参考：《中国组织工程研究》2017年15期

【摘要】：背景:外科手术重塑脊柱稳定性对修复胸腰椎爆裂性骨折具有重要作用,但伤椎植骨融合能否有效阻止矫正丢失颇有争议。目的:探讨同种异体骨椎体后外侧植骨对跨伤椎椎弓根钉置入内固定修复胸腰椎爆裂性骨折疗效的影响。方法:纳入2011年1月至2015年6月收治的80例采用跨伤椎椎弓根钉置入内固定修复胸腰椎爆裂性骨折的患者,随机分为植骨组和非植骨组,每组40例,植骨组在椎弓根钉内固定基础上行同种异体骨椎体后外侧植骨。根据患者手术时间、术中出血量及术后引流量、伤口局部情况评分、Steinman脊椎融合评分,以及术前术后椎体前缘高度、Cobb角、脊髓损伤ASIA神经功能分级及Oswestry功能障碍指数变化进行临床疗效评估。结果与结论:(1)80例患者均随访24个月。植骨组的手术时间、术中出血量以及术后引流量均大于非植骨组(P0.05);(2)与术前相比,2组患者的椎体前缘高度、Cobb角在术后均有显著改善(P0.01),但在术后随访中,植骨组与非植骨组椎体前缘高度与Cobb角均有轻度丢失,2组之间差异无显著性意义(P0.05);(3)与术前相比,2组患者术后脊髓损伤ASIA神经功能分级及Oswestry功能障碍指数均得到显著改善,但2组间差异无显著性意义(P0.05);(4)结果表明,跨伤椎椎弓根钉置入内固定是修复胸腰椎爆裂性骨折一种有效安全的方法,同种异体骨虽然能与组织较好的相容,但椎体后外侧植骨并不能有效阻止术后矫正丢失,对于椎体爆裂性骨折患者或可不必使用。
[Abstract]:Background: surgical reconstruction of spinal stability plays an important role in repairing thoracolumbar burst fracture, but it is quite controversial whether the vertebral bone graft fusion can effectively prevent the loss of correction. Objective: To explore the effect of the allograft posterior lateral bone graft on the effect of the intervertebral pedicle screw fixation for the repair of thoracolumbar burst fracture. From January 2011 to June 2015, 80 patients with thoracolumbar burst fractures treated with intervertebral pedicle screw fixation were randomly divided into bone graft group and non bone graft group, 40 cases in each group. The bone graft group was placed on the posterior external lateral bone graft on the pedicle screw fixation basis. And the postoperative flow rate, the local condition score of the wound, the Steinman spinal fusion score, the anterior height of the vertebral body, the Cobb angle, the ASIA nerve function classification and the Oswestry dysfunction index. Results and conclusions: (1) the 80 patients were followed up for 24 months. The operation time of the bone graft group and the amount of bleeding during the operation And the postoperative flow rate was greater than that of the non bone graft group (P0.05). (2) compared with the preoperative, the anterior height of the vertebral body and the Cobb angle of the 2 groups were significantly improved (P0.01), but in the follow-up period, the height of the anterior edge of the vertebral body and the Cobb angle were slightly lost in the bone graft group and the non bone graft group, and there was no significant difference between the 2 groups (P0.05); (3) 2 The ASIA neural function classification and Oswestry dysfunction index were significantly improved in the group of patients with spinal cord injury, but there was no significant difference between the 2 groups (P0.05). (4) the results showed that the intervertebral pedicle screw fixation was an effective and safe method to repair the thoracolumbar burst fracture, although the allograft could be better with the tissue. Compatibility, but posterolateral bone grafting is not effective in preventing postoperative correction loss. It is not necessary for patients with vertebral burst fractures.

【作者单位】：苏州大学附属第三医院骨科;
【分类号】：R687.3

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