经单侧椎管植骨治疗胸腰椎骨折去除内固定后回顾性分析
发布时间：2019-05-18 04:54
【摘要】：目的:探讨经后路单侧椎管伤椎植骨治疗胸腰椎骨折去除内固定后临床疗效,为临床治疗胸腰椎骨折提供初步可行性依据。方法:收集我科于2013年9月~2014年10月期间收治60例胸腰椎骨折手术取出内固定术患者病例。经查病历资料,所有患者均采用“后路伤椎骨折撑开复位,自体骨混合同种异体骨颗粒经单侧椎管椎体内植骨,椎管探查减压,椎弓根钉棒系统内固定术”,分别于手术前、术后、取出内固定后末次随访时拍摄伤椎节段X线正侧位片、CT平扫+三维重建检查,测量伤椎椎体前缘高度丢失率、椎间隙高度变化、脊柱矢状面Cobb角进行统计学分析,统计手术前、手术后24小时及末次随访时行疼痛视觉模拟评分(Visual Analogue Score,VAS)评分,观察患者术前及末次随访日本骨科协会评分(Japanese Orthopedics Association)JOA评分,针对存在神经损伤患者采用Frankel分级法评估手术前及末次随访时神经功能学恢复情况。各项数据以SPSS17.0软件处理。结果:60例患者均获得随访,男性患者32例,女性患者28例,经20~26个月随访,平均23.5个月。术后疗效评估包括:椎体前缘高度丢失率、椎间隙高度变化、脊柱矢状面Cobb角、VAS分值、JOA评分分值及神经功能恢复情况。骨折愈合时间约12周,平均14.5周。住院期间观察指标结果:脊柱矢状面Cobb角由术前(31.22±9.00)°恢复到术后的(4.13±1.33)°,伤椎前缘高度丢失率比由术前(50.23±11.01)%降到术后的(4.78±1.97)%。VAS评分由术前(6.39±1.50)分下降到(2.30±0.89)分以及JOA评分(10.33±2.94)。末次随访统计指标结果:脊柱矢状面Cobb角(4.42±1.33)°、椎体前缘高度丢失率(4.79±1.74)%、VAS评分(1.71±0.77)分、JOA评分(21.92±3.56)分,手术前19例合并神经功能损伤患者中由术前Frankel A级3例,B级4例,C级2例,D级10例(注:E级为正常)恢复到A级0例,B级2例,C级0例D级4例。术后脊髓神经功能损害无加重病例、未出现内固定器移位、断裂等情况,经统计学分析:1、手术前及手术后比较Cobb角改变、伤椎前缘高度丢失率、椎间隙高度变化、VAS评分分值差异有统计学意义(P0.05);2、手术前与末次随访时相比较Cobb角改变、伤椎椎体前缘高度丢失率、椎间隙高度变化、VAS评分分值及JOA评分分值差异有统计学意义(P0.05);3、术后及末次随访相比较:Cobb角、伤椎前缘高度丢失率、椎间隙高度差异无统计学意义(P0.05);4、手术后与末次随访时比较VAS评分分值差异有统计学意义(P0.05);5、末次随访神经功能Frankel分级评估较术前有明显的改善,差异有统计学意义(Z=-3.834,P0.05)。结论:经椎弓根螺钉撑开复位固定椎板间隙开窗单侧椎管椎体内植骨治疗胸腰椎骨折,伤椎复位好,骨折愈合可,术后神经功能恢复满意,后凸矫正后能加强脊柱的稳定性。
[Abstract]:Objective: to investigate the clinical effect of posterior unilateral spinal canal bone grafting in the treatment of thoracolumbar fractures after removal and internal fixation, and to provide preliminary feasible basis for clinical treatment of thoracolumbar fractures. Methods: from September 2013 to October 2014, 60 patients with thoracolumbar fractures were treated with internal fixation. According to the medical records, all patients were treated with "posterior vertebral fracture open reduction, autologous bone mixed with allogenic bone particles through unilateral vertebral canal bone grafting, spinal canal exploration and decompression, pedicle screw rod system internal fixation", respectively, before the operation, the patients were treated with posterior vertebral fracture open reduction, autologous bone mixed with allogenic bone particles through unilateral vertebral canal internal bone grafting, spinal canal exploration and decompression, and pedicle screw rod system internal fixation. After operation, the X-ray positive and lateral radiography of the injured vertebrae were taken at the last follow-up after internal fixation, and the three-dimensional reconstruction of the injured vertebrae was examined by CT plain scan. The loss rate of the anterior edge of the injured vertebrae, the height of the intervertebral space and the Cobb angle of the sagittal plane of the injured vertebrae were statistically analyzed. The scores of pain visual analog score (Visual Analogue Score,VAS) before operation, 24 hours after operation and the last follow-up were counted, and the (Japanese Orthopedics Association) JOA scores of patients before and after the last follow-up were observed. Frankel grading method was used to evaluate the recovery of neurological function before operation and at the last follow-up. Each data is processed by SPSS17.0 software. Results: all the 60 patients were followed up, 32 males and 28 females, with an average of 23.5 months. The postoperative evaluation included the loss rate of vertebral anterior edge height, the change of intervertebral space height, the sagittal Cobb angle, VAS score, JOA score and neurological function recovery. The fracture healing time was about 12 weeks, with an average of 14.5 weeks. The results of observation during hospitalization showed that the Cobb angle of sagittal plane of spine recovered from (31.22 卤9.00) 掳before operation to (4.13 卤1.33) 掳after operation. The ratio of height loss of anterior edge of injured vertebrae decreased from (50.23 卤11.01)% before operation to (4.78 卤1.97)% after operation. VAS score decreased from (6.39 卤1.50) to (2.30 卤0.89) and JOA score (10.33 卤2.94). The statistical results of the last follow-up showed that the Cobb angle of the sagittal plane of the spine was (4.42 卤1.33) 掳, the loss rate of the anterior edge of the vertebral body was (4.79 卤1.74)%, the VAS score was (1.71 卤0.77), and the JOA score was (21.92 卤3.56). Among the 19 patients with neurological injury before operation, there were 3 cases of Frankel grade A, 4 cases of grade B, 2 cases of grade C, 10 cases of grade D (note: grade E was normal) to 0 cases of grade A, 2 cases of grade B and 4 cases of grade D of grade C. There was no aggravation of spinal cord nerve function damage after operation, and there was no displacement and fracture of internal fixation. 1. The changes of Cobb angle, the loss rate of anterior edge of injured vertebrae and the height of intervertebral space were compared before and after operation. The difference of VAS score was statistically significant (P 0.05). 2. The changes of Cobb angle, the loss rate of anterior edge height of injured vertebrae, the height of intervertebral space, the score of VAS and the score of JOA were significantly different between before operation and the last follow-up (P 0.05). 3, there was no significant difference in Cobb angle, height loss rate of anterior edge of injured vertebrae and height of intervertebral space between postoperative and last follow-up (P 0.05). 4, there was significant difference in VAS score between postoperative and last follow-up (P 0.05). 5, the Frankel grading of the last follow-up nerve function was significantly improved compared with that before operation, the difference was statistically significant (Z 鈮，
本文编号：2479693
[Abstract]:Objective: to investigate the clinical effect of posterior unilateral spinal canal bone grafting in the treatment of thoracolumbar fractures after removal and internal fixation, and to provide preliminary feasible basis for clinical treatment of thoracolumbar fractures. Methods: from September 2013 to October 2014, 60 patients with thoracolumbar fractures were treated with internal fixation. According to the medical records, all patients were treated with "posterior vertebral fracture open reduction, autologous bone mixed with allogenic bone particles through unilateral vertebral canal bone grafting, spinal canal exploration and decompression, pedicle screw rod system internal fixation", respectively, before the operation, the patients were treated with posterior vertebral fracture open reduction, autologous bone mixed with allogenic bone particles through unilateral vertebral canal internal bone grafting, spinal canal exploration and decompression, and pedicle screw rod system internal fixation. After operation, the X-ray positive and lateral radiography of the injured vertebrae were taken at the last follow-up after internal fixation, and the three-dimensional reconstruction of the injured vertebrae was examined by CT plain scan. The loss rate of the anterior edge of the injured vertebrae, the height of the intervertebral space and the Cobb angle of the sagittal plane of the injured vertebrae were statistically analyzed. The scores of pain visual analog score (Visual Analogue Score,VAS) before operation, 24 hours after operation and the last follow-up were counted, and the (Japanese Orthopedics Association) JOA scores of patients before and after the last follow-up were observed. Frankel grading method was used to evaluate the recovery of neurological function before operation and at the last follow-up. Each data is processed by SPSS17.0 software. Results: all the 60 patients were followed up, 32 males and 28 females, with an average of 23.5 months. The postoperative evaluation included the loss rate of vertebral anterior edge height, the change of intervertebral space height, the sagittal Cobb angle, VAS score, JOA score and neurological function recovery. The fracture healing time was about 12 weeks, with an average of 14.5 weeks. The results of observation during hospitalization showed that the Cobb angle of sagittal plane of spine recovered from (31.22 卤9.00) 掳before operation to (4.13 卤1.33) 掳after operation. The ratio of height loss of anterior edge of injured vertebrae decreased from (50.23 卤11.01)% before operation to (4.78 卤1.97)% after operation. VAS score decreased from (6.39 卤1.50) to (2.30 卤0.89) and JOA score (10.33 卤2.94). The statistical results of the last follow-up showed that the Cobb angle of the sagittal plane of the spine was (4.42 卤1.33) 掳, the loss rate of the anterior edge of the vertebral body was (4.79 卤1.74)%, the VAS score was (1.71 卤0.77), and the JOA score was (21.92 卤3.56). Among the 19 patients with neurological injury before operation, there were 3 cases of Frankel grade A, 4 cases of grade B, 2 cases of grade C, 10 cases of grade D (note: grade E was normal) to 0 cases of grade A, 2 cases of grade B and 4 cases of grade D of grade C. There was no aggravation of spinal cord nerve function damage after operation, and there was no displacement and fracture of internal fixation. 1. The changes of Cobb angle, the loss rate of anterior edge of injured vertebrae and the height of intervertebral space were compared before and after operation. The difference of VAS score was statistically significant (P 0.05). 2. The changes of Cobb angle, the loss rate of anterior edge height of injured vertebrae, the height of intervertebral space, the score of VAS and the score of JOA were significantly different between before operation and the last follow-up (P 0.05). 3, there was no significant difference in Cobb angle, height loss rate of anterior edge of injured vertebrae and height of intervertebral space between postoperative and last follow-up (P 0.05). 4, there was significant difference in VAS score between postoperative and last follow-up (P 0.05). 5, the Frankel grading of the last follow-up nerve function was significantly improved compared with that before operation, the difference was statistically significant (Z 鈮，
本文编号：2479693
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