经伤椎椎弓根椎体内植骨结合椎弓根螺钉内固定治疗胸腰椎爆裂骨折的长期疗效观察

Treatment of acute thoracolumbar burst fractures with transpedicular bone grafting following indirect reduction and pedicle screw fixation: a retrospective study

目的研究经伤椎椎弓根椎体内植骨结合椎弓根螺钉治疗胸腰椎爆裂骨折的长期疗效。方法在89例胸腰椎爆裂骨折中,75例获得随访,其中52例接受了经伤椎椎弓根椎体内植骨结合椎弓根螺钉内固定手术,23例则采用了单纯后路复位、椎弓根螺钉内固定、后外侧植骨融合术。观察指标包括神经功能改善、Cobb角改变、伤椎与正常椎高度比、VAS疼痛评分改变等。结果两组患者在神经功能改善、Cobb角改变、伤椎与正常椎高度比、VAS疼痛评分改变方面无显著性差异(P>0.05),但第2组患者内固定失败率较高。结论经伤椎椎弓根椎体内植骨结合椎弓根螺钉内固定能很好恢复伤椎的高度,避免后凸畸形的复发,同时有助于临床症状的改善,而且内固定失败率较低。

Objective To evaluate the outcome of the treatment of acute thoracolumbar burst fractures by transpedicular bone grafting and pedicle screw fixation. Methods Totally 52 patients who had thoracolumbar burst fractures underwent transpedicular bone grafting and pedicle screw fixation, and were prospectively followed-up for meanly 46.35 months. Posterior reduction,pedicle screw fixation and posterolateral fusion were performed in anoth- er group of 23 patients with thoracolumbar burst fractures. And the latter group did not take transpedicular bone grafting. Results For the neurologic function,VAS score ,Cobb＇s angle and the height ratio of the injuried vertebra to normal vertebra, there was no significant difference between two groups. But the implant failure rate in the second group was much higher. Conclusion Transpedicular bone grafting with pedicle screw fixation can provide reliable neurologie improvement and well restore the height of injured vertebra and can prevent the development of kyphosis. Compared with the patients without transpedicular bone grafting, it has the lower rate of implant failure.