前路支撑植骨治疗不伴神经症状的胸腰段陈旧性骨折

Anterior approach supporting bone graft for the treatment of old thoracolumbar fractures without neurological symptom

目的:分析前路支撑植骨内固定治疗不伴神经症状胸腰段陈旧性骨折治疗效果,为胸腰段陈旧骨折的外科治疗提供参考。方法:对2006年4月至2009年4月手术治疗的胸腰椎陈旧性骨折患者22例进行回顾性分析,男15例,女7例;受伤至手术时间平均8个月(4个月～2年);年龄平均38岁(21～56岁)。均行前入路支撑植骨加前方或后方内固定术,全部患者随访时间在1年以上,术前、术后2周及术后1年通过VAS评分对患者疼痛、通过X线片对后凸Cobb角进行统计学分析,并对术后并发症进行观察。结果:术前VAS评分为(7.0±0.7)分,术后2周为(1.0±0.6)分,术后1年为(1.2±0.6)分;术前后凸Cobb角为(15.0±2.4)°(8.0°～28.0°),术后2周为(3.0±1.6)°(-2.0°～9.0°),术后1年为(3.5±1.4)°(0.0°～12.0°)。VAS评分和后凸Cobb角术前与术后2周比较,差异均有统计学意义(P<0.05),术后2周与术后1年比较,差异均无统计学意义(P>0.05)。末次随访时21例(95.5%)符合骨性融合标准,1例于术后1年截骨面未完全融合,但未出现内固定松动。结论:对于不伴神经症状而且后凸角相对较小(<30°)的胸腰段陈旧性骨折选择前路支撑植骨加前方或后方固定可取得满意疗效。

Objective：To retrospectively analyze the surgical effect of anterior approach bone graft and internal fixation methods for treating old thoracolumbar fracture without neurological symptom,so as to provide references for surgical treatment of such kind of fracture.Methods：From April 2004 to April 2009,22 cases of old thoracolumbar fractures were treated,including 15 males and 7 females with an average age of 38 years ranging from 21 to 56 years.The time from injured to operation was from 4 months to 2 years（caverage 8 months）.Anterior approach surporting bone graft and internal fixation were performed.All patients were followed up for at least 12 months,the Cobb angle depending on lateral radiographs and VAS scores were compared between pre-oprative and post-oprative.Complication was observed.Results：The average preoperative Cobb angle of kyphosis was（15.0±2.4）°（8.0° to 28.0°）,VAS score was 7.0±0.7.The average two weeks after operation was（3.0±1.6）°（-2.0° to 9.0°）,VAS score was 1.0±0.6.The average Cobb angle at one year after operation was（3.5±1.4）°（0.0° to 12.0°）,VAS score was 1.2±0.6.There were statistically significant differences in the above indexes between preoperation and two weeks after operation（P〈0.05）,while no statistically significant difference was found between 2 weeks and 1 year after operation（P〉0.05）.Bony fusion were achieved in 21 patients,nounion were occurred in 1 patient,but without correction loss.Conclusion：According to Cobb angle of kyphosis,anterior approach surporting bone graft and internal fixation is a reasonable strategy to treat old thoracolumbar fracture without neurological symptom.