个体化伤椎单侧置钉联合植骨术治疗胸腰椎爆裂骨折

Individualized unilateral pedicle screw placement combined intrabody bone grafting on fractured vertebrae for thoracolumbar burst fractures

[目的]观察胸腰椎爆裂骨折患者行个体化伤椎单侧置钉联合伤椎内植骨术的临床疗效。[方法]回顾性分析2016年4月~2018年2月胸腰椎爆裂骨折行伤椎置钉短节段固定患者60例,根据术中是否经椎弓根伤椎体内植骨分为二组,30例为植骨组,其余30例为非植骨组。比较两组临床资料。[结果]两组患者均顺利完成手术。植骨组手术时间长于非植骨组,差异有统计学意义(P<0.05);术中出血量和术口长度比较差异无统计学意义(P>0.05)。所有患者术后随访12~33个月。两组患者VAS评分均随时间推移显著减少(P<0.05),术后相同时间点两组间VAS评分差异无统计学意义(P>0.05)。影像检查方面,术后两组椎体前缘压缩率、Cobb角均较术前显著改善(P<0.05),术后1周时两组间差异无统计学意义(P>0.05),末次随访时植骨组显著优于非植骨组(P<0.05),植骨组有6例,非植骨组有24例残留"空壳"征,差异有统计学意义(P<0.05)。植骨组无内固定松动、断裂等,非植骨组4例椎弓根钉根部断裂,3例连接棒断裂,差异有统计学意义(P<0.05)。[结论]后路个体化伤椎单侧置钉联合打压植骨术治疗胸腰椎爆裂骨折可显著恢复并维持伤椎椎体高度及Cobb角,促进骨折愈合。

[Objective]To observe the clinical outcomes of individualized unilateral pedicle screw placement combined transpedicular intrabody bone grafting on affected vertebrae for thoracolumbar burst fractures.[Methods]A retrospective study was performed on 60 patients who received short-segment internal fixation with unilateral pedicle screw placement on the fractured vertebrae for thoracolumbar burst fractures from April 2016 to February 2018.Based on whether or not transpedicular intrabody bone grafting on the affected vertebrae conducted during surgical procedures,30 patients fell into the bone grafting(BG)group,while the remaining 30 patients were in the non-bone grafting(NBG)group.The clinical data were compared between the two groups.[Results]All the 60 patients got successful surgical operations.The BG group proved significantly more timeconsuming,associated with more intraoperative blood loss and longer incision than the NBG group(P<0.05).The follow-up period lasted for 12~33 months.The VAS scores significantly decreased over time in both groups(P<0.05),with no a statistically significant difference at any paralleling time point between the two groups(P>0.05).In term of radiographic assessment,both the compression ratio of the fractured vertebra and Cobb angle significantly improved after operative compared with those preoperatively(P<0.05).Although no significant differences in the two radiographic parameters were noticed between the two group at 1 week after operation(P>0.05),the BG group was significantly superior to the NBG group at the latest follow up(P>0.05).At the latest follow up,"hollow body"sign on radiographs was found in 6 patients of the BG group,whereas 24 patients of the NBG group,which was statistically significant(P<0.05).In addition,no implant loosening or breaking happened in anyone of the BG group,whereas 4 cases of pedicle screw breaking and3 case of rod linker fracture were noted in the NBG group,which was statistically significant(P<0.05).[Conclusion]This individualized pedicle screw placement combined transpedicular intrabody bone grafting on affected vertebrae does improve restoration and maintenance of the vertebral height and Cobb angle,associated with enhancement of fracture healing for thoracolumbar burst fractures.