椎弓根钉内固定并不同植骨方法治疗胸腰椎爆裂性骨折临床分析

Clinical analysis of thoracolumbar burst fractures by the method of pedicle screw internal fixation system with bone grafting

[目的]通过对椎弓根钉内固定结合不同植骨方法治疗不同程度胸腰椎爆裂性骨折的疗效及其影响因素的分析,探讨椎体植骨的适应证和必要性。[方法]通过104例病例回顾分析,根据影像学结果,比较经椎弓根椎体内植骨、椎板间植骨和单纯内固定无植骨的术后即时及随访时的临床效果。[结果]椎体压缩≤Ⅱ度时经椎弓根椎体内植骨组椎体前、后缘高度,后凸成角较术前矫正良好,但与椎板间植骨组和单纯内固定无植骨组比较不具有统计学差异(P>0.05)。椎体压缩≥Ⅲ度时经椎弓根椎体内植骨组椎体前、后缘高度,后凸成角较术前矫正良好,并且与椎板间植骨组和单纯内固定无植骨组比较具有统计学差异(P<0.05)。[结论]经椎弓根椎体内植骨与其他植骨方法比较能即时增加椎体骨容量和脊柱前中柱的抗压稳定性,有效填充严重压缩导致的椎体内骨缺损,防止远期矫形丢失及内固定失效。

[Objective]To summarize and evaluate the effects and the correlative factors of thoracolumbar burst fractures by pedicle screw internal fixation system with bone graft of vertebral body via pedicle in order to discuss the vertebral bone graft indication and necessity.[Method]Retrospective analysis was made in 104 cases,the clinical effect of immediate and at follow-up of the imaging results were compared in the transpedicular interbody grafting group,vertebral lamina bone grafting group and the pure fixation without bone graft group after surgery.[Result]When vertebral compression≤Ⅱdegrees,the anterior height and posterior height ratio of the group interbody bone grafting and the Cobb angulation showed satisfactory effect.The difference among three groups were not statistically significant（P0.05）.When vertebral compression≥Ⅲ degrees,the anterior height and posterior height ratio of the group interbody bone grafting and the Cobb angulation showed satisfactory effect.The difference among the three groups were statistically significant（P0.05）.[Conclusion]Bone graft of vertebral body via pedicle can instantly increases vertebral bone capacity and spinal compressive stability,effectively correct vertebral malformation,reduce vertebral further compression and ratio of internal fixation failure.