短节段非融合椎弓根螺钉结合伤椎植骨治疗胸腰椎骨折的疗效

Outcomes of short-segment non-fusion pedicle-screw and transpedicular grafting in treating thoracolumbar fracture

目的探讨短节段非融合椎弓根螺钉结合伤椎植骨治疗胸腰椎骨折的中期疗效。方法选取胸腰椎骨折患者60例,采用短节段非融合椎弓根螺钉固定,根据联合伤椎置钉或伤椎植骨将患者分为植骨组(30例)和置钉组(30例)。比较两组手术时间、术中出血量;术后Cobb角、椎体前缘高度比及骨缺损情况;采用美国脊柱损伤学会(ASIA)运动神经评分及Frankel分级评估患者手术前后的神经功能。结果植骨组手术时间较置钉组长[(100.53±13.42)min vs.(92.43±13.69)min](P<0.05);植骨组术中出血量较置钉组多[(304.60±34.25)ml vs.(286.53±29.23)ml](P<0.05)。术后两组Cobb角和椎体前缘高度比均较术前恢复(P<0.05),但两组Cobb角和椎体前缘高度比差异无统计学意义(P>0.05)。术后2年,植骨组伤椎骨缺损程度小于置钉组[(6.6±0.3)%vs.(18.3±1.2)%](P<0.01)。末次随访时,两组ASIA运动神经评分分别为(48.5±5.5)分和(49.0±4.8)分,差异无统计学意义(P>0.05);内固定前Frankel分级C级、D级的患者均恢复至E级。结论在短节段非融合椎弓根螺钉内固定治疗中,经伤椎植骨和置钉均为满意的辅助手段,但经伤椎植骨后可以明显填补骨缺损,促进骨折愈合。

Objective To evaluate the mid-term clinical outcomes of short segment non-fusion pedicle screw （SSNFPS） and transpedicular grafting （TPG） in the treatment of thoracolumhar fractures. Methods Sixty patients with thoracolumhar fractures were treated with SSNFPS and TPG （group A, 30 cases） or TPG alone （group B, 30 cases）. The surgery-related parameters were compared. Results Compared to group B, group A had a longer operation time[（ 100.53±13. 42） minutes vs. （92.43 ±13. 69） minutes] （P〈0.05） and more intraoperative blood loss[（304. 60 ±34. 25） ml vs. （286. 53±29.23） ml]（P〈0. 05）. The Cobb angles and anterior vertebral height ratios were better after surgry than those before in both groups（P〈0. 05）. The outcomes of two years follow up showed that the improvement of bone loss in the injured vertebrae was better in group A than that in group B（P〈0. 01 ）, the ASIA scores of motor nerves of two groups were similar[ （48. 5 ± 5. 5）points vs. （49. 0 ± 4. 8） points] （P〉0. 05）, and the Frankel grade C and grade D were all returned to grade E. Conclusion Compared to SSNFPS alone, additionally use of TPG can fill the bone defects of the injured vertebrae and accelerate the heeling of fractured vertebrae.