钛网融合器与自体髂骨植骨在胸腰椎爆裂骨折前路手术中的应用比较研究

Comparative study of application of fusion with titanium mesh and autogenous iliac bone graft in anterior thoracolumbar burst fracture surgery

目的比较研究胸腰椎爆裂骨折前路手术应用钛网融合器与自体髂骨植骨后临床与影像学长期结果,比较二者椎间隙高度变化与程度并评价神经功能恢复情况。方法对56例分别采用钛网融合器植骨和自体髂骨植骨的患者进行随访,时间6～24个月,平均13.6个月,根据伸屈位X线片有无活动及骨性连接判断是否骨性融合,同时测量椎间隙高度的变化并根据患者主诉及查体判断神经恢复情况。结果随访的56例均获得了骨性融合,融合率100%,融合时间6～14个月,平均9个月,应用钛网椎间植骨的26例中21例出现椎间隙塌陷,发生率80.8%,椎间隙高度变化在(3.9±1.8)mm,髂骨椎间植骨的30例中25例出现椎间隙塌陷,发生率83.3%,椎间隙高度变化在(3.8±1.9)mm。获骨性融合时椎间隙高度再无明显变化。所有患者神经功能情况按Frankel分级均有、级以上的改善。结论应用钛网融合器与取自体髂骨植骨在胸腰椎爆裂骨折前路手术治疗效果上无显著差异。

Objective To compare the long-term clinical and radiological results of anterior fusion with titanium mesh and autologous bone grafts for treatment of the thoracolumbar burst fracture by measuring the disc height and extent of changes and evaluating nerve recovery. Methods Fifty six patients received fusion with titanium mesh and autogenous iliac bone graft were followed up for 6-24 months, 13.6 months on average. The flexion and extension movements and the presence of bone connection were checked with X-ray film to determine whether bone fusion was achieved. The changes in disc height were measured and the physical examination was performed with patients＂ complaints to determine the neurological recovery. Results All patients received bone fusion, with the fusion rate at 100%, and integration time ranged from 6 to 14 months, with an average of 9 months. The disc space collapse occurred in 21 of 26 patients received titanium mesh interbody fusion, with the occurrence rate of 80.8%, and the changes in disc height were （3.9~1.8）mm. The disc space collapse occurred in 25 of 30 patients received iliae bone graft with the occurrence rate of 83.3%, and changes in disc height were（3.8~l.9）mm. Bone fusion disc height didn＇t change when bone fusion was achieved. Nerve function in all cases was graded according to Frankel grading with at least one level improvement. Conclusion There＇s no significant difference in the effect of surgical treatment for anterior thoraeolumbar burst fracture between fusion with titanium mesh and autologous iliae bone graft.