单侧椎板开窗植骨内固定术治疗胸腰椎爆裂骨折的疗效评价

发布时间：2018-07-16 16:16

【摘要】：目的:探讨单侧椎板开窗减压植骨联合短节段内固定术治疗胸腰椎爆裂骨折的疗效。分析伤椎爆裂类型、荷载分享等级(Load Sharing Classification,LSC)评分、邻近解剖结构破坏程度、固定与植骨术等与伤椎愈合的相关性,旨在为胸腰椎爆裂骨折术式选择、疗效随访提供参考指标。方法:经伦理委员会批准,本研究共纳入胸腰椎爆裂骨折(Denis A/B型)38例。男30例、女8例,年龄41.21±12.37岁,伤椎包括T12(4例)、L1(18例)、L2(9例)、L3(7例),平均随访时间(27.26±8.47)个月;Denis爆裂骨折分型:A型24例、B型14例;收集整理病例临床及影像学资料,分析伤椎爆裂类型、LSC评分、邻近椎管解剖结构破坏程度、植骨术等对伤椎愈合的影响;1)比较术前、术后、术后三个月及末次随访的椎管通畅率(α)、伤椎前缘高度比(H)、前后缘高度比(BI)、矢状面cobb角(CA)、伤椎楔变角(VWA);2)基于Mimics平台评价部分病例伤椎植骨区三维重建的愈合转归;3)分析中枢或和外周神经功能情况(ASIA分级)、并发症发生等。结果:影像学评价参数:1)LSC评分:5~8分、平均7.06±0.87分;2)术前、末次随访椎管通畅率((56.66±13.07)%、(92.47±3.80)%)差异有统计学意义(p0.05),伤椎前缘高度比、伤椎前后缘高度比、Cobb角、伤椎楔变角,术前与术后及各阶段随访比较,均有差异(p0.05);3)术后与术后三个月,伤椎前缘高度比、伤椎前后缘高度比、Cobb角、伤椎楔变角无统计学差异(p0.05);4)术后与末次随访,伤椎前缘高度比、伤椎前后缘高度比、Cobb角差异均有统计学意义(p0.05),伤椎楔变角无统计学差异(p0.05);5)术后三个月与末次随访,伤椎前缘高度比、伤椎前后缘高度比、伤椎楔变角无统计学差异(p0.05),Cobb角有统计学差异(p0.05)。伤椎内部三维重建:术后1例,植骨体积3477.76mm3;末次随访8例,同一伤椎愈合区域上位层面CT值普遍低于下位层。神经损伤恢复,除1例A级患者,均有一级以上好转。无脑脊液漏、神经损伤加重及感染,3例矢状位Cobb角丢失10°,1例断棒。结论:后路椎板间隙开窗椎管减压、经椎管前壁椎体植骨成形联合短节段内固定术治疗治疗胸腰椎爆裂骨折(Denis A/B型)的疗效良好,针对荷载分享高分值病例,本术式可作为选择参考;基于MIMICS平台伤椎内部三维重建可客观评价伤椎骨折影像学转归。
[Abstract]:Objective: to investigate the effect of unilateral laminectomy decompression and bone grafting combined with short segment internal fixation in the treatment of thoracolumbar burst fracture. The relationship between burst type of injured vertebra, load sharing classification (LSC) score, damage degree of adjacent anatomical structure, fixation and bone grafting, and the healing of injured vertebrae were analyzed. The purpose of this study was to provide a reference index for the choice of surgical methods and follow-up of thoracolumbar burst fracture. Methods: 38 cases of thoracolumbar burst fracture (Denis A / B type) were included in this study. There were 30 males and 8 females aged 41.21 卤12.37 years old. The injured vertebrae included T12 (4 cases), L1 (18 cases), L2 (9 cases) and L3 (7 cases). The average follow-up time was (27.26 卤8.47) months. The LSC score of burst type of injured vertebra, the degree of destruction of anatomic structure of adjacent spinal canal and the influence of bone grafting on the healing of injured vertebra were analyzed. Spinal canal patency rate (伪), anterior height ratio (H), anterior and posterior height ratio (BI), sagittal cobb angle (CA), vertebral wedge angle (VWA) 2) were evaluated based on imics platform. To analyze the central or peripheral nerve function (Asia grade), complications and so on. Results: there were significant differences in the imaging parameters (1: 1) LSC score: 5 ~ 8 (mean 7.06 卤0.87) before and after operation (56.66 卤13.07), (92.47 卤3.80)% (p0.05), anterior height ratio, anterior and posterior height ratio (Cobb angle), wedge angle (P < 0.05), spinal canal patency rate (56.66 卤13.07), anterior height ratio (P 0.05), anterior and posterior height ratio (P < 0.05), vertebral wedge angle (P < 0.05). The ratio of anterior height of injured vertebrae, the ratio of anterior height of injured vertebra to Cobb angle, the ratio of anterior and posterior height of injured vertebrae to Cobb angle, and the angle of wedge change of injured vertebra were not significantly different between preoperative and postoperative follow-up (p0.05) and 3 months after operation (p0.05), the ratio of anterior height of injured vertebrae to that of anterior edge of injured vertebra was not significantly different (p0.05). There were significant differences in the anterior and posterior edge height of the injured vertebrae (p0.05), but there was no significant difference in the angle of vertebral wedge change (p0.05) in the 3 months and the last follow-up after the operation, the ratio of the anterior height of the injured vertebra to that of the anterior edge of the injured vertebra, the ratio of the anterior and posterior edge height of the injured vertebra. There was no statistical difference (p 0.05) in wedge angle of injured vertebrae (p 0.05), and there was significant difference in Cobb angle (p 0.05). Three dimensional reconstruction of injured vertebrae: 1 case, bone graft volume 3477.76 mm 3, and 8 cases at the last follow-up, the CT value of the upper layer of the same wound vertebra healing area was generally lower than that of the lower layer. The recovery of nerve injury, except for one patient with grade A, was improved at or above the first level. No cerebrospinal fluid leakage, aggravated nerve injury and 3 cases of sagittal Cobb angle loss were found in 1 case. Conclusion: the treatment of thoracolumbar burst fracture (Denis A / B type) with decompression of posterior laminectomy, anterior wall vertebroplasty and short segment internal fixation is effective. This procedure can be used as a reference for selection, and 3D reconstruction based on MIMICS platform can objectively evaluate the imaging outcome of traumatic vertebral fracture.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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