植骨融合复位固定在胸腰椎爆裂性骨折中的应用

Fixation with pedicle screw system plus transpedicular grafting in the treatment of thoracolumbar fracture.

目的探讨椎弓根螺钉复位内固定结合伤椎内植骨融合治疗胸腰椎爆裂性骨折的临床效果。方法回顾性分析2009年1月至2011年10月在我科治疗的53例胸腰段骨折患者,其中24例使用后路椎弓根内固定加椎弓根椎体内植骨治疗为观察组,29例使用后路椎弓根内固定方法治疗为对照组。比较两组患者术前、术后以及随访的伤椎前后缘高度比值、Cobb's角的矫正情况等。结果①治疗前后行组内比较发现,对照组和观察组椎体前缘压缩率升高均较显著(P<0.05),两组手术前后Cobb's角减少均较显著(P<0.05)。②治疗后与随访期行组内比较发现,观察组椎体前缘压缩率、Cobb's角的数值差异无统计学意义(P>0.05);而对照组椎体前缘压缩率随访期间较术后显著降低(P<0.05),Cobb's角则显著增加(P<0.05);③随访期间观察组椎体前缘压缩率和Cobb's角的恢复均显著优于对照组(P<0.05)。结论在爆裂型骨折患者中复位固定联合植骨融合术后及长期效果明显,具有重要的临床意义。

Objective To explore the clinical effect of fixation with pedicle screw system plus transpedicular grafting in the treatment of thoracolumbar fracture. Methods Fifty-three patients with thoracolumbar fractures from January 2009 to October 2011, were devided into 24 patients （Observation group） treated with posterior fixation with pedicle screw system plus transpedicular grafting, and 29 patients （Control group） were treated purely with posterior fixation with pedicle screw system. Anterior body compression, Cobb＇s angles correction and fracture healing of preoperative, postoperative and follow-up were compared between the two groups. Results ①Both observation group and control group have made improvement in mean anterior body compression compare to itself before treatment （P0.05）.Compared with that in the preoperative, the mean anterior body compression and Cobb＇s angles of observation group in the postoperative has no obvious loss （P0.05）, and the mean anterior body compression of control group has enlarged while Cobb＇s angles decreased obviously （P0.05）. Observation group had received better clinical effect than control group in the aspect of mean anterior body compression and Cobb＇s angles （P0.05）. Conclusion Posterior fixation with pedicle screw system plus transpedicular grafting is an effective method in the treatment of thoracolumbar fracture, with important significance.