经伤椎椎弓根植骨结合椎弓根钉内固定治疗胸腰椎骨折35例

35 Cases of Transpedicular Intervertebral Bone Graft in Injured Vertebrae and Pedicle Screw Fixation for the Treatment of Thoracolumbar Fracture

目的:探讨经伤椎椎弓根植骨结合椎弓根钉内固定治疗胸腰椎骨折的临床效果。方法:按照患者实际选择治疗方案将65例胸腰椎骨折患者分为观察组(经伤椎椎弓根植骨+椎弓根钉内固定)35例和对照组(椎弓根钉内固定)30例,比较两组患者治疗情况及预后效果。结果:两组患者治疗后椎体前缘高度均明显高于治疗前,Cobb角均明显低于治疗前,分别为(95.33±8.47)%与(49.85±5.22)%,(4.32±1.06)°与(27.33±3.58)°,(94.01±8.30)%与(49.97±5.30)%,(5.10±1.13)°与(27.29±3.62)°(P<0.05);两组患者治疗后椎体前缘高度、Cobb角以及神经功能提高1级、2级所占比例差异无统计学意义,分别为(95.33±8.47)%与(94.01±8.30)%,(4.32±1.06)°与(5.10±1.13)°,20.00%与6.67%,11.43%与10.00%(P>0.05);观察组患者随访结束后椎体前缘丢失高度、Cobb角丢失度、ODI以及疼痛程度均明显低于对照组,分别为(1.55±0.20)%与(7.31±1.46)%,(1.25±0.38)°与(7.39±1.52)°,(15.46±4.38)与(24.16±4.59),60.00%与33.33%(P<0.05);观察组患者随访期间内固定失效率明显低于对照组,分别为0.00%与20.00%(P<0.05)。结论:经伤椎椎弓根植骨结合椎弓根钉内固定术后椎体前缘高度及Cobb角丢失更少,腰背部功能及疼痛改善效果更佳,内固定失效率更低,值得临床推广。

Objective： To explore the clinical effect of transpedicular intervertebral bone graft in injured vertebrae and pedicle screw fixation for the treatment of thoracolumbar fracture. Methods： 65 cases of thoracolumbar fracture were divided into experimental group（35 cases of transpedicular intervertebral bone graft in injured vertebrae and pedicle screw fixation）and control group（30 cases of pedicle screw fixation）. The treatment and prognosis of the two groups were compared.Results： After treatment, the anterior vertebral height of the two groups was significantly higher than that before treatment,（95.33±8.47）% vs（49.85±5.22）%,（94.01±8.30）% vs（49.97±5.30）%, and Cobb＇s angle were significantly lower than that before treatment（4.32±1.06）° vs（27.33±3.58）°,（5.10±1.13）°vs（27.29±3.62）°（P〈0.05）.There was no significant difference in the height of anterior vertebral body height, Cobb ＇s angle and nerve function recovery rate between the two groups after treatment,（95.33±8.47）% vs（94.01±8.30）%,（4.32±1.06）° vs（5.10±1.13）°,20.00% vs 6.67%,11.43% vs 10.00%（P〉0.05）. By the end of follow-up, the anterior vertebral height loss, Cobb ＇s angle loss degree, ODI and degree of pain in the experimental group were significantly lower than those in the control group（1.55±0.20）% vs（7.31±1.46）%,（1.25±0.38）°vs（7.39±1.52）°,15.46±4.38 vs 24.16±4.59,60.00% vs 33.33%（P〈0.05）.The failure rate in the experimental group was significantly lower than that in the control group during the follow-up period（0.00% vs 20.00%）（P〈0.05）. Conclusion： Transpedicular intervertebral bone graft in injured vertebrae and pedicle screw fixation has many advantages such as lower vertebral height and Cobb＇s angle loss, the better waist back function and pain improvement effect, the lower internal fixation failure rate. It is worthy of clinical promotion.