经椎弓根椎体内植骨与后外侧植骨治疗胸腰椎爆裂骨折的影像学研究

Comparison of the grafting technique in treatment of thoracolumbar burst fractures： transpedicular intracorporeal versus posterolateral

目的 探讨经椎弓根椎体内植骨与后外侧植骨在胸腰椎爆裂骨折治疗中的作用.方法 对1999年1月至2009年12月手术治疗的46例椎体内植骨患者与18例后外侧植骨患者进行长期随访,于术前、术后、内固定取出前及末次随访时,测量矢状位X线片后凸角、伤椎楔变角、伤椎前后缘高度比、伤椎上间隙角、下间隙角的变化,进行对比分析,并通过CT、MRI观察植骨融合和椎间盘塌陷及其对后凸矫正丢失的影响.结果 椎体内植骨组伤椎楔变角由术前的27.2°±6.5°矫正至术后的7.0°±3.0°,伤椎前后缘高度比由术前的（53.3±11.8）%矫正至术后的（92.3±2.4）%;后外侧植骨组伤椎楔变角由术前的23.9°±4.4°矫正至术后的8.8°±2.1°;伤椎前后缘高度比由术前的（60.7±10.0）%矫正至术后的（88.5±3.3）%;椎体内植骨组优于后外侧植骨组,差异均有统计学意义（P＜0.05）.终末随访时两组后凸角、伤椎楔变角、伤椎前后缘高度比矫正丢失差异均有统计学意义（P＜0.05）,而伤椎上、下间隙角的丢失差异无统计学意义（P＞0.05）.结论 椎体内植骨的＂撑起＂复位作用,早期可以比后外侧植骨更好地恢复伤椎形态和脊柱序列,但并不能阻止内固定取出后的晚期椎间隙塌陷和矫正度丢失.

Objectives To retrospectively investigate the outcome of transpedicular intracorporeal grafting and posterolateral grafting in treatment of thoracolumbar burst fractures. Methods Forty-six patients treated with transpedicular intracorporeal grafting from January 1999 to December 2009 and followed up for 19-119 months （ average 67 ± 13 months） were reviewed retrospectively, and were compared with 18 patients who had underwent posterolateral fusion during the same period through radiographic analysis. Radiographic measurements included Cobb angle, vertebral wedge angle （ VWA）, ratio between anterior and posterior vertebral height （APHR）, upper inter-vertebral angle, lower inter-vertebral angle on X-ray, CT and MRI. Results In transpedicular intracorporeal grafting group, the VWA was corrected from 27.2°±6. 5° to 7. 0°± 3.0° and the APHR from （53. 3 ± 11.8 ） % to （92. 3 ± 2. 4 ） % . In posterolateral fusion group, the VWA was corrected from 23.9°± 4. 4° to 8. 8°± 2. 1 ° and the APHR from （ 60. 7 ± 10. 0 ） % to （ 88. 5±3. 3 ）%. Transpedicular intracorporeal grafting group showed better postoperative correction results than posterolateral fusion group （P ＜0. 05）, and had less loss of correction of Cobb angle, VWA and APHR at final follow-up （P ＜ 0. 05 ）. Conclusions The transpedicular intracorporeal grafting can improve injured vertebral body morphology recovery better than posterolateral bone grafting, but can not prevent the late loss of correction after implant removal.