小关节植骨融合术治疗胸腰椎爆裂性骨折疗效观察

The efficacy of bone graft fusion of facet joint in the treatment of thoracolumbar burst fractures

目的探讨小关节植骨融合术治疗胸腰椎爆裂性骨折的疗效。方法104例胸腰椎爆裂性骨折患者,采用随机数字表法分为两组各52例。对照组采取横突间植骨融合术,观察组采取小关节植骨融合术。比较两组围术期指标、骨性融合率、内固定失效率,观察手术前后影像学指标、疼痛程度、功能障碍程度。结果观察组术中出血量、植骨量少于对照组,手术时间、术后住院时间、骨折愈合时间短于对照组(P<0.05);两组术后1、6月伤椎前缘、中央、后缘高度丢失率及Cobb角、VAS评分、ODI均较术前降低(P<0.05),术后1月,观察组前缘高度丢失率、中央高度丢失率高于对照组,VAS评分、ODI低于对照组(P<0.05),术后6月,两组上述指标比较差异无统计学意义(P>0.05);末次随访时,两组骨性融合率、内固定失效率比较差异无统计学意义(P>0.05)。结论小关节植骨融合术可减轻胸腰椎爆裂性骨折患者手术创伤和术后疼痛,有利于功能恢复,缩短住院时间,取得较好的远期疗效。

Objective To explore the efficacy of bone graft fusion of facet joint in the treatment of thoracolumbar burst fractures.Methods A total of 104 patients with thoracolumbar burst fracture were divided into observation or control group according to the random number table method,52 in each group.The control group was treated with intertransverse bone graft fusion,and the observation group was treated with facet joint bone graft fusion.The perioperative indicators,bony fusion rate and internal fixation failure rate were compared between the two groups,and the imaging indicators,pain level and dysfunction degree were observed before and after surgery.Results The intraoperative blood loss and bone graft volume in the observation group were less than those in the control group,and the surgical time,postoperative hospital stay and fracture healing time were shorter than those in the control group(P<0.05).After 1 month and 6 months of surgery,the loss rates of anterior height,central height and posterior height of injured vertebrae,Cobb angle,VAS score and ODI score in the two groups were lower than those before surgery(P<0.05).After 1 month after surgery,the loss rate of anterior height and loss rate of central height in the observation group were higher than those in the control group while the VAS score and ODI score were lower than those in the control group(P<0.05).After 6 months of surgery,there were no statistically significant differences in the above indicators between the two groups(P>0.05).At the last follow-up,there were no statistically significant differences in the bony fusion rate and internal fixation failure rate between the two groups(P>0.05).Conclusion Facet joint bone graft fusion can reduce the surgical trauma and postoperative pain in patients with thoracolumbar burst fractures.It is conducive to functional recovery and can shorten hospital stay and achieve a good long-term efficacy.