后路减压-经伤椎椎弓根局部自体骨植骨治疗胸、腰段脊柱脊髓损伤

Intracorporeal grafting treatment of thoracolumbar burst fracture by transpedicle of vertebral arch

目的总结后入路减压同时经伤椎椎弓根向伤椎椎体内植骨,行椎弓根钉-棒系统内固定治疗胸、腰腰段脊柱脊髓损伤的疗效。方法后入路经伤椎弓根向伤椎椎体内植骨,同时行椎管环形或次环形减压、短节段或长节段椎弓根钉-棒系统内固定治疗胸、腰椎爆裂骨折83例,其中59例获得随访。术前及随访时行X线和CT检查,测量伤椎椎体中央高度值,比较术后椎体高度的恢复程度,同时观察植骨融合情况。采用配对t检验方法进行统计学分析。结果全部病例均无植骨操作所致的神经血管损伤并发症,无感染。CT检查显示椎体内植骨块融合良好,术后平均随访24.5个月,伤椎椎体中央高度值[T12(3.07±0.34)cm,L1(3.19±0.35)cm]与正常值[T12(3.21±0.35)cm,L1(3.35±0.50)cm]比较,无显著性差异(P>0.05)。结论后路行椎管减压及内固定的同时,经伤椎椎弓根向椎体内植骨,能够达到恢复伤椎椎体高度,重建损伤阶段的前、中柱的稳定性,也能预防术后远期发生椎体塌陷。局部自体骨取材方便,较异体骨费用低廉,较取髂骨并发症少有一定优越性。

Objective To study and evaluate intraeorporeal grafting treatment effects and significance by transpediele vertebral arch on thoraeolumbar fractures.Methods 83 cases with thoraeolumbar fractures were treated by intraeorporeal grafting transpediele vertebral arch combined with circumscribed decompression and short segmental transpediele fixation.The middle height of the injured vertebrae was measured postoperatively at CT image and analyzed by paired Student^t test at many diferent time of follow-up.Results There were 59 cases had been followed-up and The followed-up time was 24.5 months in average.There was no infection and no neurological and vascular complications correlated with this technique and instruments.The shape and the height of injured vertebrae were maintained,and the fusion of grafting bone was observed.No significant diference was found in middle height of the injured vertebrae[Tl2（3.07±0.34）cm,Ll（3.19±0.35）cm]compared with that of the normal[Tl2（3.21±0.35）cm,Ll（3.35±0.50）cm]（P〉0.05）.Conclusion Intraeorporeal grafting by transpediele of vertebral arch combined with decompression and fixation is one of the treatments of thoraeolumbar burstfractures to prevent vertebrae body subside postoperatively.