Denis B型胸腰椎爆裂性骨折伤椎植骨与椎间植骨疗效比较

Comparison of the clinical effects between vertebral bone graft and interbody bone graft in the treatment of Denis type B thoracolumbar vertebral burst fractures

目的比较Denis B型胸腰椎爆裂性骨折行后路短节段固定结合伤椎植骨与椎间植骨两种植骨方法的临床疗效。方法回顾性分析在我院治疗的40例Denis B型胸腰段爆裂性骨折的病人,按手术方法进行分组,伤椎植骨组(后路短节段固定结合伤椎经椎弓根植骨),椎间植骨组(后路短节段固定结合伤椎椎间植骨),统计两植骨组手术时间、术中出血量及术前、术后即刻、末次随访时Cobb角和伤椎及其上位椎间隙高度,进行分析。结果所有患者均获得随访,平均随访19个月,两组患者手术时间、术中出血量比较差异有统计学意义(P<0.05),两组患者术前与术后即刻Cobb角、伤椎及其上位椎间隙高度比较,差异有统计学意义(P<0.05);末次随访时与术后即刻Cobb角、伤椎及其上位椎间隙高度比较,差异无统计学意义(P>0.05),平均矫正丢失度,伤椎植骨组大于椎间植骨组。结论合并椎间盘损伤的Denis B型胸腰椎爆裂性骨折采用后路短节段固定结合椎间植骨的治疗方法疗效可靠,能重建伤椎高度,恢复前中柱支撑,促进骨折愈合。

Objective To compare the clinical result of posterior short-segment instrumentation combined with vertebral bone grafting and interbody bone grafting in the treatment of Denis type B thoracolumbar burst fractures. Methods Retrospectively analyzed 40 cases of Denis type B thoracolumbar burst fractures in our hospital. They were divided into two groups according to the different operation methods： group of vertebral bone grafting and interbody bone grafting. The data of operation time,blood loss in the two groups were recorded and preoperative, postoperative, at the time of the last follow-up Cobb angle, vertebral and superior intervertebral space height were compared and analyzed. Results All the 40 patients were followed up for 19 months for average. There was significant difference between the two groups in operation time and blood loss（P〈0.05）. The differences of the Cobb angle, the height of injured vertebral body and the upper intervertebral space were statistically significant before and after operation（P〈0.05）, there was no difference between postoperation and the end of the follow-up（P〉0.05）,while the average correction loss of vertebral bone graft group was greater than that of the interbody bone graft group. Conclusion The effect of posterior short-segment fixation combined with interbody bone grafting in the treatment of Denis type B thoracolumbar fracture with intervertebral disc injury is reliable, it can reconstruct the height of vertebral body, restore the support of anterior and middle column and promote the healing of fracture.