患椎棘突骨板在胸腰椎脊柱骨折PLF手术中应用的效果观察

Effect observation of application with vertebral spinous process bone plate in PLF operation for thoracic and lumbar spine bone fractures

目的比较胸腰椎脊柱骨折经后路切开复位椎弓根钉棒系统内固定植骨(PLF)手术不同骨源植骨的临床疗效。方法将65例胸腰椎脊柱骨折患者随机分为3组,均行PLF手术。A组20例取髂骨瓣植骨,B组21例行同种异体骨植骨,C组24例行患椎棘突骨板植骨。结果手术时间:A组(128±25)min,B组(95±7)min,C组(92±5)min;术中出血量:A组(563±135)mL,B组(351±60)mL,C组(336±57)mL;A组手术时间与出血量与B组和C组比较均有显著性差异。A组、C组患者术后切口均I期愈合;B组出现排异反应4例,2例行异体骨取出清创术后愈合2,例经长期换药愈合。3组均无死亡、神经功能损害加重及内固定器械松动断裂等情况发生。A组发生术后取骨区疼痛7例占35%,B组发生伤口痛、渗液4例占19%,C组无不良并发症发生。术后A组及C组胸腰椎骨性融合率均为95%,B组融合率为84%。术后3个月、6个月、12个月神经功能损伤评分3组比较均无显著性差异。结论胸腰椎脊柱骨折取患椎棘突骨板植骨能保证术后融合率,恢复脊柱的远期稳定,其较取髂骨与同种异体骨操作简便、安全经济、创伤小、并发症少,是一种值得临床推广的植骨思路。

Objective It is to compare the clinical curative effect of different source of bone graft in posterior pedicle screw fixation and posterolateral fusion （PLF） surgery for thoracic and lumbar spine bone fractures. Methods Sixty-five cases of patients with thoracic and lumbar spine bone fracture were randomly divided into 3 groups, and all were treated with PLF surgery. Group A （n = 20） used routine iliac bone graft, group B （n = 21 ）used allogeneic bone graft, group C （n = 24） suffered from vertebral spinous process bone plate graft. Results The operation time： group A （128 ± 25 ） min, group B （95 ± 7）min, group C （92 ±5） min; surgery bleeding： group A （563 ± 135） mL, group B （351±60） mL, group C （336 ±57） mL; compared with that in group A, the differences in surgery time and bleeding in group B and group C were significant. Post-operative incisions had primary healing in group A and group C, there were 4 cases of rejection, 2 cases of healing after allogeneic debridement, 2 cases of long-term dressing healing in group B. No death, neurological damage increase and loosening of internal fixation fracture was found in all the groups. There were 7 cases of pbstoperative pain （35%） in group A, 4 eases of wound pain, effusion （19%）in group B, and no side complication was found in group C. The thoracic vertebrae spinous process fusion rate was 95% in both group A and group C, and that of group B was 84%. After 3 months, 6 months, 12 months, the differences in neurological injury by ASIA standard score among the three groups was not significant （ P 〉 0. 05 ）. Conclusion Vertebral spinous process bone plate graft for thoracic and lumbar spine vertebral spinous process fracture can ensure postoperative bone fusion rate and restore the long-term stability of the spine, it is simple, safe and economic with less injury and complications compared with allograft bone graft and routine iliac bone graft, is an idea worthy of clinical practice of bone grafting.