短节段固定结合伤椎置钉、植骨治疗胸腰椎骨折的临床研究

Comparative study of the short segment fixation in combination of pedicle screw fixation with bone graft of vertebral body via pedicle for thoracolumbar fractures

目的探讨后路短节段椎弓根钉固定结合伤椎椎弓根钉固定加伤椎经椎弓根植骨成形术治疗胸腰椎骨折的方法和效果。方法 2005年3月至2010年3月治疗组采用传统短节段椎弓根钉固定结合经伤椎椎弓根钉固定和椎体内植骨成形术治疗32例胸腰椎骨折,以同期随机选择的采用传统短节段椎弓根钉固定术治疗的30例胸腰椎骨折为对照组进行临床对比研究,分别测量两组病例术前、术后及末次随访时伤椎椎体前缘高度、脊柱矢状位Cobb角,椎管内占位百分比,以ASIA2000分级标准评定神经功能;以Charles标准评定临床疗效,并进行统计学分析。结果术后平均随访17.2个月(12～21个月),放射学评估两组患者术后的脊柱重建均较术前有明显改善,两组术后即刻伤椎高度恢复方面疗效相当,但对照组在术后脊柱的后凸矫形和骨折块复位方面较治疗组差(P<0.05)。末次随访时治疗组与对照组伤椎椎体前缘高度、脊柱矢状位Cobb角两组比较差异均有统计学意义(P<0.05),神经功能和临床疗效评估两组比较差异均无统计学意义,并发症治疗组2例,对照组5例。结论经伤椎椎弓根植骨加伤椎固定结合短节段椎弓根钉固定可提高骨折后凸畸形的矫正度,使脊柱和内固定物的载荷更合理、更稳定,降低了内固定失效和矫形丢失的发生,促进了骨折愈合,是弥补传统短节段椎弓根螺钉内固定手术不足的有效方法。

Objective To disscuss the clinical method and outcome of pedicle screw fixation plus bone graft of vertebral body via pedicle for thoracolumbar fractures.Methods Sixty-two patients treated from 2005 to 2010 were reviewed.Thirty were treated by short segment fixation （treatment group）,thirty-two were treated by shortsegment pedicle instrumentation combined with trans-pedicular intracorporeal bone grafting and fixation at the level of the fracture（control group）.Radiological evaluation was made for measuring Cobb＇s angle,the percentage of the anterior and posterior height of injured vertebra and spinal space-occupying rate after operation and during the last follow up.Meanwhile,ASIA 2000 classification standards were used to investigate neurological function and Charles＇ standard to evaluate clinical efficacy.Results All the patients achieved fracture union during the last follow-up with a mean period of 17.2 months（range 12-21 months）.Radiological evaluation of spinal reconstruction in postoperative were more greatly than preoperative in two groups,but there were same in immediate recover height of injured vertebra.Kyphosis correction and reset fractured vertebra in control group were weaker than treatment group （P ＜0.05）.At the last follow-up,compared with control group,Cobb＇s angle,the percentage of the anterior and posterior height of injured vertebra and spinal space-occupying rate in treament group were much better.Neural functions showed 1 to 3 grade improvement compared with the findings before operation.There was no difference between two group.The treatment group had 2 cases of complications and the control group had 5 cases.Conclusions Shortsegment pedicle instrumentation combined with trans-pedicular intracorporeal bone grafting and fixation at the level of the fracture can correct kyphosis and restore the height of vetebra.Meanwhile,it can make load of spine and internal fixation more reasonable and stable,and can reduce incidence rate of internal fixation failure and orthopaedic lost.It is an effcient method to make up for the lack of short segment fixation.