经椎弓根植入生物人工材料骨诱导人工骨加内固定治疗骨质疏松性胸腰段骨折

Treatment of osteoporotic thoracolumbar fractures with transpedicular graft of biological artificial material-induced artificial bone plus internal fixation

目的探讨经椎弓根植入生物人工材料（biologicalartificialmaterial，BAM）骨诱导人工骨结合椎弓根螺钉内固定治疗骨质疏松性胸腰段骨折的临床疗效。方法选择2005—2010年收治的72例骨质疏松性胸腰段骨折患者。采用经椎弓根撬拨复位、BAM骨诱导人工骨植入、后路椎弓根螺钉内固定治疗。收集患者资料并进行随访，所有患者术前、术后以及随访期间行脊柱正、侧位X线片检查，测量伤椎椎体前后缘高度、胸腰段后凸Cobb角、前后椎体高度比。采用美国脊髓损伤协会（ASIA）分级评估神经功能恢复情况，视觉模拟评分（visualanalogscale，VAS）评估腰背部疼痛。结果患者随访12-28个月，平均18．3个月。患者均获骨性愈合，未发生人工骨移植物排斥反应或内固定松动断裂等并发症，椎体高度及畸形矫正度无明显丧失。除2例FrankelA级患者神经功能无恢复外，其余患者神经功能明显改善。VAS由术前（8．4±2．5）分降至末次随访时的（2．2±1．6）分，患者腰背部疼痛明显缓解。结论经椎弓根植骨内固定术是治疗骨质疏松性胸腰段骨折有效合理、简单易行的方法，植入的BAM骨诱导人工骨具备良好的生物学和力学性能。

Objective To investigate the clinical effects of transpedicular graft of biological artifi- cial material （BAM） -induced artificial bone and posterior pedicle screw fixation in the treatment of osteo- porotic thoracolumbar fractures. Methods A total of 72 patients with osteoporotic thoracolumbar frac- tures treated by transpedicular reduction by leverage, BMA-induced artificial bone grafting and posterior pedicle screw fixation from 2005 to 2010 were reviewed and followed up. The frontal and lateral X-ray radi- ograph of the spine was performed before and after operation and during the follow-up. The anterior and pos- terior height of the injured vertebrae, thoraeolumbar kyphotic angle （ Cobb＇ s angle）, ratio of anterior to posterior vertebral height were determined. Also, the America Spinal Injury Association （ASIA） scale was used to evaluate the neurological recovery and the visual analog scale （VAS） was applied to assess the back and waist pain. Results All patients were followed up for a mean period of 18.3 months, ranging from 12 to 28 months. Meanwhile, all the patients obtained bone union, with no rejection of artificial bone graft, breakage or loosening of screws, or obvious loss of both vertebrae height and deformity correction angle. No- table improvement of neurological function was achieved in all patients except for two patients with Frankel A nerve injury. The VAS score descended from pre-operative （8.4 ± 2.5 ） points to （2.2±1.6）points at latest follow-up, which showed obvious alleviation of back and waist pain. Conclusions Transpedieular bone graft plus internal fixation is an effective, reasonable and easy method for managing osteoporotic thora- columbar fractures. In addition, the implanted BAM-induced artificial bone is of good biological and me- chanical properties.