取髂骨重建椎板治疗胸腰段椎体骨折合并脊髓损伤的临床效果

Clinical effect of vertebral lamina reconstruction with iliac bone in treatment of thoracolumbar fracture with spinal function impairment

目的:评价取髂骨重建椎板治疗胸腰段椎体骨折合并脊髓损伤的临床效果。方法:2009-01~2014-06收治的胸腰段椎体骨折合并脊髓损伤患者256例,分为两组,观察组行后路椎板切除减压、椎弓根内固定取髂骨重建椎板植骨融合术,对照组行后路椎板切除减压、椎弓根内固定横突间植骨融合术。比较两组患者治疗前后神经功能Frankel分级、疼痛评分(VRS)、椎管面积、伤椎前缘高度与正常高度比值、Cobb角、内固定失效率、椎管再发狭窄发生率。结果:两组患者神经功能Frankel分级、VRS评分、椎管面积均明显改善,组间比较均无显著性差异。两组患者术后1个月伤椎前缘高度与正常高度比值、Cobb角较术前明显改善;观察组术后12个月伤椎前缘高度与正常高度比值优于对照组,Cobb角增加少于对照组。观察组术后内固定失效率及椎管再发狭窄发生率低于对照组。结论:取髂骨重造椎板能有效避免胸腰段椎体骨折患者术后椎体高度丢失及再发后凸畸形,避免继发椎管狭窄压迫脊髓导致神经功能损害,能有效减少患者术后麻木、疼痛等不良并发症的发生,提高患者生存质量。

Objective：To evaluate the clinical effect of vertebral lamina reconstruction with iliac bone in treatment of thoracolumbar fracture with spinal function impairment.Methods：A total of 256 cases in treatment of thoracolumbar fracture with spinal function impairment from January 2009 to June 2014 in our department were divided into the observation group and control group.The observation group were treated with posterior decompression,pedicle screw fixation and laminoplasty with iliac bone,while the control group were treated with intertransverse fusion.The neurologic Frankel classification,spinal canal area,VRS score,vertebrae height recover ratio,Cobb angle,internal fixation failure and spinal canal restenosis of two groups were compared.Results：Patients＇ neurologic Frankel classification,VRS score decrease,spinal canal area were significantly improved in two groups,the comparison between groups showed no difference.Patients＇ postoperative vertebral height and Cobb angle were obviously improved compared with preoperative in two groups,while the vertebral height of observation group was better than that of control group,and the Cobb angle increase was less than that of control group in 12 months after operation.The internal fixation failure rate and vertebra canal restenosis rate were lower in observation group.Conclusion：Vertebrae plate reconstruction with iliac bone is a good method for treatment of thoracolumbar fracture,as it can obviously decrease postoperative vertebral height loss and kyphosis deformity,avoiding neural function damage caused by spinal canal restenosis,reducing postoperative adverse complications,and improving patients＇ quality of life.