后路经伤椎单侧椎弓根通道植骨并置钉短节段内固定修复胸腰段椎体爆裂性骨折

Short pedicle screw segment with bone graft through unilateral pedicle channel and pedicle screw fixation for thoracolumbar burst fractures by posterior operation

背景:短节段椎弓根钉技术治疗和修复胸腰椎爆裂性骨折在临床应用广泛,但经伤椎单侧椎弓根通道内植骨是否具有优越性仍需要进一步研究。目的:观察后路伤椎单侧椎弓根通道植骨并置钉短节段内固定修复胸腰椎爆裂性骨折的围手术期效果。方法:回顾性分析银川市第一人民医院骨科2009年1月至2013年12月采用短节段椎弓根钉内固定方法治疗的57例非合并神经症状单节段胸腰段椎体爆裂性骨折患者的临床资料,按照治疗方式分为跨伤椎短节段椎弓根钉内固定组(n=21)、伤椎单侧置钉短节段椎弓根钉内固定组(n=19)、伤椎单侧椎弓根通道并植骨置钉短节段椎弓根钉内固定组(n=17)。观察手术时间、术中出血量、治疗后引流血量(拔管为标准)、伤椎前缘高度比、伤椎矢状面Cobb角、伤椎椎管侵占率、目测类比评分等指标变化。结果与结论:1单侧椎弓根通道植骨并置钉技术可延长手术时间和增加治疗后引流血量(P<0.05)。23种治疗方式均可恢复椎体高度。3治疗后3组间Cobb角比较差异无显著性意义(P>0.05),提示椎弓根通道植骨在围手术期并非改善后凸畸形的因素。4椎弓根通道植骨为改善椎管侵占率的因素。5椎弓根通道植骨并置钉可改善治疗后疼痛情况。提示后路经伤椎单侧椎弓根通道植骨并置钉短节段椎弓根钉内固定是修复胸腰段椎体爆裂性骨折安全可靠的方法之一。

BACKGROUND：Short-segment pedicle screw technology has been extensively used in the treatment and repair of thoracolumbar burst fractures in the clinic. However, it requires further investigations whether bone graft through unilateral pedicle channel has superiority. OBJECTIVE：To observe the perioperative effects on thoracolumbar burst fractures posterior by bone graft through unilateral pedicle channel with short pedicle screw segment fixation. METHODS：Clinical data of 57 cases of thoracolumbar burst fractures without neurological symptoms treated by short segment pedicle screw internal fixation therapeutic method at the Department of Orthopedics, The First People’s Hospital of Yinchuan City from January 2009 to December 2013 were retrospectively analyzed.＆amp;nbsp;According to therapeutic methods, they were divided into three groups：pedicle screw fixation through injured vertebrae （n=21）, unilateral pedicle screw fixation with vertebrae pedicle screw （n=19）, and the short segment pedicle screw fixation with unilateral pedicle screw fixation and bone graft through pedicle channel （n=17）. We observed the changes in operation time, the blood loss volume in operation, postoperative drainage blood （at the period of removing the drainage tube）, injured vertebrae height’s ratio, the Cobb’s angel of injured vertebrae sagittal plane, vertebral canal encroachment rate and visual analog scale. RESULTS AND CONCLUSION：（1） The unilateral pedicle screw fixation and bone graft by pedicle channel could prolong operation time and increase postoperative drainage blood volume （P〈0.05）. （2） Three operation methods improved vertebral body height. （3）There were no significant differences in Cobb’s angle postoperation among the three groups （P〉0.05）. These data suggested that the bone graft through pedicle channel was not the factors to improve the spine kyphosis. （4） Bone graft by pedical channel improved vertebrae channel value. （5） Bone graft through pedicle channel combined with screw implantation could improve pain after treatment. These findings indicated that the therapeutic technology of short pedicle screw fixation on thoracolumbar vertebral burst fracture with unilateral pedicle fixation and bone graft through pedicle channel is a safe reliable operation method.