不同植骨方式后路短节段固定治疗胸腰椎爆裂性骨折疗效观察

Clinical effect of different bone grafting methods for posterior short segment fixation in the treatment of thoracolumbar burst fracture

目的比较两种植骨方式后路短节段固定治疗胸腰椎爆裂性骨折患者的临床疗效。方法回顾性分析2015年1月至2019年4月在西安市第九医院骨科接受手术治疗的100例胸腰椎爆裂性骨折患者的临床资料,所有患者均接受后路短节段固定术治疗,按照植骨方式不同分为A组(椎板及横突间植骨)和B组(小关节翻转植骨),每组50例。比较两组患者围术期情况,术后1年时骨性融合情况,术前、术后1周及术后1年时Cobb角及丢失情况,术前及术后1年时Oswestry功能障碍指数(ODI)的变化及安全性。结果A组患者的手术时间、术中出血量、植骨量分别为(151.34±14.69)min、(520.11±79.12)mL、(15.05±2.14)cm^3,B组分别为(130.93±15.07)min、(467.84±57.08)mL、(14.84±2.62)cm^3,A组患者的手术时间、术中出血量均明显长于或多于B组,差异均有统计学意义(P<0.05),但两组患者的植骨量比较差异无统计学意义(P>0.05);A组和B组患者术后1年时的骨性融合率分别为88.0%、86.0%,差异无统计学意义(P>0.05);术后1年时,A组患者的Cobb角、矫正度丢失分别为(14.07±2.31)°、(9.78±1.95)°,B组分别为(14.51±1.79)°、(10.15±1.40)°,差异均无统计学意义(P>0.05);A组和B组患者术后1年时的ODI评分分别为(14.98±3.01)分、(15.11±2.41)分,差异无统计学意义(P>0.05);A组和B组患者的内固定失败发生率均为2.0%,差异无统计学意义(P>0.05)。结论椎板及横突间植骨、小关节翻转植骨均有助于促进胸腰椎爆裂性骨折腰椎功能恢复,而小关节翻转植骨具有手术时间短、术中出血量较少的优势。

Objective To compare the clinical effect of two bone grafting methods for posterior short segment fixation in the treatment of thoracolumbar burst fracture.Methods The clinical data of 100 patients with thoracolumbar burst fractures who received surgical treatment from January 2015 to April 2019 in Department of Orthopedics,Xi'an Ninth Hospital were retrospectively analyzed.All patients were treated with posterior short segment fixation.According to the different methods of bone grafting,they were divided into group A(lamina and transverse process bone graft)and group B(facet joint turnover bone graft),with 50 patients in each group.The perioperative conditions,bone fusion at 1 year after operation,the changes of the Cobb angle and loss before operation,1 week and 1 year after operation,and the changes of the Oswestry disability index(ODI)before operation and 1 year after operation and safety were compared among the two groups.Results The operation time,intraoperative blood loss,bone graft volume in group A were(151.34±14.69)min,(520.11±79.12)mL,(15.05±2.14)cm^2,respectively,which were significantly longer or more than corresponding(130.93±15.07)min,(467.84±57.08)mL,(14.84±2.62)cm^2 in group B(P<0.05);1 year after operation,the bone fusion rates in group A was 88.0%versus 86.0%in group B(P>0.05);1 year after operation,the Cobb angle and correction loss in group A were(14.07±2.31)°and(9.78±1.95)°versus(14.51±1.79)°and(10.15±1.40)°in group B(P>0.05);1 year after operation,the ODI scores in group A was(14.98±3.01)points versus(15.11±2.41)points in group B(P>0.05);the failure rates of internal fixation in group A and group B was both 2.0%(P>0.05).Conclusion The lamina and transverse process bone graft and facet joint turnover bone graft can promote the recovery of lumbar function of thoracolumbar burst fracture,while facet joint turnover bone graft have the advantages of short operation time and less blood loss.