自制植骨通道下经伤椎椎弓根植骨置钉手术治疗胸腰椎骨折的疗效分析

Clinical effect of transpedicular vertebral arch grafting and pedicle screws in injured vertebra under assistance of self-made bone grafting channel for thoracolumbar vertebral fractures

目的探讨自制植骨通道辅助下经伤椎椎弓根植骨置钉手术治疗胸腰椎骨折的临床疗效。方法回顾性分析自2010-02—2016-09在自制植骨通道下经伤椎椎弓根植骨置钉治疗的39例胸腰椎骨折。比较术前、术后3 d、末次随访时伤椎椎体前缘高度、伤椎Cobb角。结果 39例均获得随访,随访时间平均15.9(11～27)个月。随访期间未出现感染、骨折不愈合等并发症,内固定物均未见松动、断裂。术后X线片及CT显示伤椎内植骨愈合良好。术后3 d伤椎椎体前缘高度较术前明显增加,伤椎Cobb角较术前明显减小,差异有统计学意义(P <0.05)。末次随访与术后3 d时伤椎椎体前缘高度、伤椎Cobb角比较差异无统计学意义(P>0.05)。结论自制植骨通道下经伤椎椎弓根植骨、经伤椎短节段椎弓根钉内固定治疗胸腰椎骨折可取得良好的疗效,可有效恢复伤椎高度并维持远期后凸畸形矫正效果。

Objective To explore the clinical effect of transpedicular vertebral arch grafting and pedicle screws in injured vertebra under the assistance of self-made bone grafting channel for thoracolumbar vertebral fracture.Methods A retrospective analysis was performed on 39 cases of thoracolumbar fractures,which treated with transpedicular vertebral arch grafting and pedicle screws in injured vertebra under the assistance of self-made bone grafting channel from February 2010 to September 2016.The anterior margin height and Cobb angle of the injured vertebrae were compared before surgery,3 d after surgery and at the last follow-up.Results All the 39 patients were followed up for 11 to 27 months,an average of 15.9 months.During the follow-up,there were no complications such as infection and fracture nonunion,and no loosening or fracture of the internal fixation.Postoperative X-ray and CT showed good healing of the injured vertebral bone graft.Three days after surgery,the anterior margin height of the injured vertebrae was significantly higher than that before surgery,and the Cobb angle of the injured vertebrae was significantly lower than that before surgery,with statistically significant differences(P<0.05).At the last follow-up,there was no statistically significant difference in the height of the anterior vertebral body and the Cobb angle of the injured vertebrae between the two groups 3 days after surgery(P>0.05).Conclusion Transpedicular vertebral arch grafting and pedicle screws in injured vertebra under the assistance of self-made bone grafting channel for thoracolumbar vertebral fracture can achieve good clinical effect,which can effectively restore the height of the injured vertebrae and maintain the long-term correction effect of kyphosis.