脊柱后路椎间隙自体骨植骨结合长节段固定治疗C型胸腰段骨折

Posterior intervertebral autogenous bone grafting combined with long-segment fixation for type C thoracolumbar fractures

目的探讨脊柱后路椎间隙自体骨植骨结合长节段固定治疗C型胸腰段骨折的疗效。方法采用回顾性病例系列研究分析2013年1月—2016年1月解放军联勤保障部队第903医院收治的28例C型胸腰段骨折脱位患者的临床资料,其中男20例,女8例;年龄25~55岁,平均36.8岁。骨折均为AO分型C型。损伤节段:T11~12 5例,T12~L1 8例,L1~2 9例,L2~3 6例。术前胸腰椎损伤分类与严重度评分(TLICS)为7~9分[(8.0±1.1)分],载荷分享评分(LSC)为7~10分[(8.5±1.4)分]。美国脊髓损伤协会(ASIA)分级:A级20例,B级8例。均行脊柱后路椎间隙自体骨植骨结合长节段固定治疗。记录手术时间、手术出血量及并发症发生情况。比较术前、术后1周、术后3,12,24个月局部后凸Cobb角、腰背痛视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI)。胸腰椎CT三维重建评估植骨融合情况。采用ASIA分级评估神经功能恢复情况。结果患者均获随访24~36个月,平均26个月。手术时间和术中出血量分别为(135.8±30.5)min和(350.5±50.7)ml。术中未发生血管损伤、神经损伤加重等严重并发症;术后未发生切口感染、内固定松动断裂等并发症。术后1周、术后3,12,24个月局部后凸Cobb角均较术前明显改善(P<0.01);术后1周、术后3,12,24个月,VAS和ODI均较术前明显改善(P<0.01)。末次随访时椎间隙植骨均已融合。末次随访ASIA分级:A级20例,B级3例,C级5例。结论脊柱后路椎间隙自体骨植骨结合长节段固定,手术操作简单、手术时间短、创伤小,植骨融合效果良好,患者术后疼痛及神经功能较术前明显改善,可作为一种治疗C型胸腰段骨折的手术方案选择。

Objective To investigate the efficacy of posterior intervertebral autogenous bone grafting combined with long-segment fixation for type C thoracolumbar fractures.Methods A retrospective case series study was performed in 28 patients with type C thoracolumbar fractures admitted to the 903 Hospital of PLA from January 2013 through January 2016.There were 20 males and eight females,aged 25-55 years,with an average of 36.8 years.All patients had type C fractures according to the new AO classification system.The injury occurred at T11-12 segment in 5 patients,T12-L1 segment in 8,L1-2 segment in 9,and L2-3 segment in 6.These patients were scored 7-9 points[(8.0±1.1)points]according to the thoracolumbar injury classification and severity score(TLICS)and 7-10 points[(8.5±1.4)points]according to Load sharing score(LSC).There were 20 patients with grade A and eight patients with grade B based on the American Spine Injury Association(ASIA).All patients were treated with posterior intervertebral autogenous bone grafting combined with long-segment fixation.The operation time and volume of blood loss were recorded.Kyphosis Cobb angle,visual analogue scale(VAS)and Oswestry disability index(ODI)were compared between before operation and 1 week,3 months,12 months and 24 months after operation.Bone grafting union was evaluated during the follow-up period by CT scan.ASIA grade was used to evaluate the functional recovery.Results All patients were followed up for average 26 months(range,24-36 months).The operation time was(135.8±30.5)minutes and the intraoperative blood loss was(350.5±50.7)ml,respectively.No serious complications occurred during the operation such as blood vessel or nerve injury aggravation.No serious complications occurred after operation such as incision infection and internal fixation loosening or fracture.Cobb angles of local kyphosis at 1 week,3,12 and 24 months after operation were significantly improved compared with preoperative Cobb angle(P<0.01).VAS and ODI were also significantly improved at 1 week,3,12 and 24 months after operation(P<0.01).The last follow-up found that all the intervertebral bone grafts were fused.At the last follow-up,ASIA grading results were as follows:grade A in 20 patients,grade B in 3 and grade C in 5.Conclusion Posterior intervertebral autogenous bone grafting combined with long-segment fixation has the advantages of simple operation,short operation time,minimal trauma,good fusion effect,significant relief of the pain and improvement of neurological function,indicating a surgical option for the treatment of type C thoracolumbar fracture.