经椎板间隙小开窗与经椎弓根椎体内植骨治疗胸腰椎爆裂型骨折的比较研究
发布时间：2019-03-07 15:12
【摘要】：目的探讨经椎板间隙小开窗与经椎弓根椎体内植骨治疗Denis A、B型胸腰椎爆裂型骨折的重建效果和远期稳定性差异。方法回顾分析2012年1月—2014年2月,采用椎体内植骨成形联合椎弓根钉棒系统内固定术治疗的50例Denis A、B型胸腰椎爆裂型骨折患者的临床资料。其中,30例术中采用经伤椎椎板间隙小开窗椎体内植骨(A组),20例采用经伤椎单侧椎弓根椎体内植骨(B组)。两组患者除术前Cobb角比较,差异有统计学意义(P0.05)外,性别、年龄、致伤原因、伤后至手术时间、骨折分型、损伤节段以及术前神经功能Frankel分级、伤椎前缘高度百分比、疼痛视觉模拟评分(VAS)等一般资料比较,差异均无统计学意义(P0.05)。记录并比较两组患者后凸Cobb角、伤椎前缘高度百分比及腰背部疼痛、神经功能恢复情况。结果两组患者均获随访,A组随访时间16~31个月,平均19.1个月;B组17~25个月,平均20.2个月。两组术后切口均Ⅰ期愈合,无神经损伤等手术相关并发症发生。两组术前存在神经功能损伤患者,除Frankel A级患者外,其余患者神经功能均有不同程度改善。两组患者腰背部疼痛均较术前缓解,术后3个月、末次随访时VAS评分与术前比较,差异均有统计学意义(P0.05);两组间术后各时间点间比较,差异无统计学意义(P0.05)。X线片复查示,随访期间两组均未发生断钉、退钉、断棒、内固定松动等;伤椎椎体内植骨填充良好,植骨融合。术后伤椎椎体高度均恢复良好,A、B组术后1周、3个月及末次随访时伤椎前缘高度百分比及后凸Cobb角与术前比较,差异有统计学意义(P0.05);术后各时间点间比较,差异均无统计学意义(P0.05)。两组间术后各时间点以上两指标比较,差异均无统计学意义(P0.05)。结论对于Denis A、B型胸腰椎爆裂型骨折,经椎板间隙小开窗或经椎弓根进行椎体内植骨联合椎弓根钉棒系统内固定术治疗均能较好恢复椎体高度和矫正后凸并维持椎体稳定,降低了内固定物松动、断裂等并发症发生风险。因此,可根据患者椎管占位严重程度、椎体塌陷情况及脊髓神经损伤程度,选择合适植骨通道。
[Abstract]:Objective to investigate the difference of reconstruction effect and long-term stability of Denis A and B thoracolumbar burst fractures treated by small fenestration through laminar space and bone graft through pedicle vertebra in the treatment of thoracolumbar burst fracture. Methods from January 2012 to February 2014, the clinical data of 50 patients with thoracolumbar burst fracture (Denis A, B) treated with vertebroplasty and pedicle screw fixation were retrospectively analyzed. Among them, 30 cases were treated with bone graft through small window of laminar space (group A), and 20 cases were treated with bone grafting through unilateral pedicle vertebra of injured vertebra (group B), among which 30 cases were treated with bone graft through the small fenestrated space of vertebral lamina (group A). The difference of Cobb angle before operation between the two groups was statistically significant (P0.05), gender, age, cause of injury, time from injury to operation, fracture classification, Frankel grade of injured segment and preoperative nerve function, percentage of anterior edge height of injured vertebra. There was no significant difference in pain visual analogue score (VAS) and other general data (P0.05). The Cobb angle of kyphosis, the percentage of anterior edge height of injured vertebrae, the pain of waist and back and the recovery of nerve function were recorded and compared between the two groups. Results the patients in both groups were followed up for 16 months 31 months (mean 19.1 months) and group B 17 months 25 months (average 20.2 months). There were no operative complications such as nerve injury and wound healing in both groups. There were patients with neurologic impairment before operation in both groups. Except for Frankel A patients, the neurological function of the other patients were improved to some extent. There was significant difference in VAS scores between the two groups at the last follow-up 3 months after the operation (P0.05). The pain in the back and waist of the two groups were relieved compared with those before the operation (P0.05). There was no significant difference between the two groups at each time point after operation (P0.05). X-ray examination showed that there were no broken nails, screw removal, broken rods and loosening of internal fixation in the two groups during the follow-up period; the injured vertebrae were well filled with bone graft and fused with bone graft. In group A, the percentage of anterior edge height and kyphosis Cobb angle at 1 week, 3 months and last follow-up were significantly different from those before operation (P0.05). There was no significant difference between the time points after operation (P0.05). There was no significant difference between the two groups at each time point after operation (P0.05). Conclusion for Denis A and B thoracolumbar burst fractures, the vertebral body height can be recovered and the kyphosis can be corrected and the stability of the vertebral body can be maintained by internal fixation of vertebral body with bone graft combined with pedicle screw system through the small window of the lamina space or through the pedicle of vertebrae in the treatment of thoracolumbar burst fracture of Denis A and B type. It reduces the risk of complications such as loosening and breaking of the internal fixator. Therefore, appropriate bone graft channels can be selected according to the degree of vertebral canal occupation, vertebral body collapse and spinal cord nerve injury.
【作者单位】： 遵义医学院附属医院脊柱外科;
【基金】：贵州省科学技术基金课题资助项目(2010J2179) 遵义医学院博士科研启动基金资助项目(201019)~~
【分类号】：R687.3
[Abstract]:Objective to investigate the difference of reconstruction effect and long-term stability of Denis A and B thoracolumbar burst fractures treated by small fenestration through laminar space and bone graft through pedicle vertebra in the treatment of thoracolumbar burst fracture. Methods from January 2012 to February 2014, the clinical data of 50 patients with thoracolumbar burst fracture (Denis A, B) treated with vertebroplasty and pedicle screw fixation were retrospectively analyzed. Among them, 30 cases were treated with bone graft through small window of laminar space (group A), and 20 cases were treated with bone grafting through unilateral pedicle vertebra of injured vertebra (group B), among which 30 cases were treated with bone graft through the small fenestrated space of vertebral lamina (group A). The difference of Cobb angle before operation between the two groups was statistically significant (P0.05), gender, age, cause of injury, time from injury to operation, fracture classification, Frankel grade of injured segment and preoperative nerve function, percentage of anterior edge height of injured vertebra. There was no significant difference in pain visual analogue score (VAS) and other general data (P0.05). The Cobb angle of kyphosis, the percentage of anterior edge height of injured vertebrae, the pain of waist and back and the recovery of nerve function were recorded and compared between the two groups. Results the patients in both groups were followed up for 16 months 31 months (mean 19.1 months) and group B 17 months 25 months (average 20.2 months). There were no operative complications such as nerve injury and wound healing in both groups. There were patients with neurologic impairment before operation in both groups. Except for Frankel A patients, the neurological function of the other patients were improved to some extent. There was significant difference in VAS scores between the two groups at the last follow-up 3 months after the operation (P0.05). The pain in the back and waist of the two groups were relieved compared with those before the operation (P0.05). There was no significant difference between the two groups at each time point after operation (P0.05). X-ray examination showed that there were no broken nails, screw removal, broken rods and loosening of internal fixation in the two groups during the follow-up period; the injured vertebrae were well filled with bone graft and fused with bone graft. In group A, the percentage of anterior edge height and kyphosis Cobb angle at 1 week, 3 months and last follow-up were significantly different from those before operation (P0.05). There was no significant difference between the time points after operation (P0.05). There was no significant difference between the two groups at each time point after operation (P0.05). Conclusion for Denis A and B thoracolumbar burst fractures, the vertebral body height can be recovered and the kyphosis can be corrected and the stability of the vertebral body can be maintained by internal fixation of vertebral body with bone graft combined with pedicle screw system through the small window of the lamina space or through the pedicle of vertebrae in the treatment of thoracolumbar burst fracture of Denis A and B type. It reduces the risk of complications such as loosening and breaking of the internal fixator. Therefore, appropriate bone graft channels can be selected according to the degree of vertebral canal occupation, vertebral body collapse and spinal cord nerve injury.
【作者单位】： 遵义医学院附属医院脊柱外科;
【基金】：贵州省科学技术基金课题资助项目(2010J2179) 遵义医学院博士科研启动基金资助项目(201019)~~
【分类号】：R687.3
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