经椎弓根植骨联合椎弓根钉内固定治疗胸腰段椎体爆裂骨折

Transpedicular bone grafting combined with pedicle screw fixation on thoracolumbar burst fracture

目的探讨经椎弓根植骨联合椎弓根钉内固定对胸腰段椎体爆裂骨折患者的临床疗效。方法对我院2014年3月至2016年12月收治的80例胸腰段椎体爆裂骨折的患者进行随访分析,其中40例(观察组)采用经椎弓根植骨联合椎弓根钉内固定治疗,其余40例(对照组)采用单纯后路切开复位椎弓根钉内固定治疗;术后随访1年,采用ASIA评分法对两组患者手术前后神经功能分级进行评价,定期复查X片检查比较两组患者椎体前缘高度、Cobb角、椎管占位率,并对治疗前后VAS评分、ODI指数以及Beck指数进行比较。结果两组手术时间、出血量、手术前后ASIA评级差异无统计学意义(P>0.05),术后1年椎体前缘高度观察组高于对照组,而Cobb角以及椎管占位率均明显低于对照组,差异有统计学意义(P<0.05)。观察组VAS评分、ODI指数显著低于对照组,Beck指数显著高于对照组,差异具有统计学意义(P<0.05)。结论经椎弓根植骨联合椎弓根钉内固定对胸腰段椎体爆裂骨折可获得较好的脊柱稳定性,纠正椎体高度和后凸畸形,减少椎管内骨块占位,缓解疼痛,值得推广。

Objective： To investigate the clinical effect of transpedicular bone grafting combined with pedicle screw fixation on thoracolumbar burst fracture. Methods： The follow-up analysis of 80 cases of thoracolumbar vertebral burst fractures treated in our hospital from March 2014 to December 2016,of which 40 cases（observation group） had pedicle bone grafting and pedicle screw fixation. After treatment,the remaining 40 patients（control group） were treated with simple posterior incision and pedicle screw fixation. The patients were followed up for 1 year. The neurological function grading was evaluated by ASIA before and after the operation. The X-ray examination was performed regularly to compare the anterior height of the vertebral body,Cobb＇s angle,and vertebrae. Tube occupation rate,and comparison of VAS score,ODI index,and Beck index was made before and after treatment. Results： There was no significant difference in operative time,blood loss,and ASIA ratings between the two groups（P〈0. 05）. The vertebral body height in the observation group was higher than that in the control group at 1 year after surgery,and the Cobb angle and the occupancy rate of the spinal canal were significantly. lower than those of the control group,and the difference was statistically significant（P〈0. 05）. VAS score and ODI index was significantly lower in the observation group than those in the control group,Beck index was significantly higher than that of the control group,and the difference was statistically significant（P〈0. 05）. Conclusion： Transpedicular screw fixation combined with pedicle screw fixation can obtain better spine stability for thoracolumbar burst fractures,correct vertebral height and kyphotic deformity,reduce bone mass in the spinal canal,relieve pain,which is worth promoting.