后路手术植骨方案差异对胸腰椎单椎体爆裂性骨折患者疗效及影像学参数的影响

Influence of Different Bone Graft Schemes in Posterior Surgery on Clinical Efficacy and Imaging Parameters of Patients with Thoracolumbar Single Vertebral Burst Fracture

目的探讨后路手术植骨方案差异对胸腰椎单椎体爆裂性骨折患者疗效及影像学参数的影响。方法回顾性分析我院2016年1月-2020年1月收治的129例胸腰椎单椎体爆裂性骨折患者的临床资料,根据治疗方案分为A组(43例)、B组(44例)及C组(42例),A组行伤椎椎弓根椎体内植骨,B组行椎板/横突间植骨,C组行小关节翻转植骨。比较3组内固定融合率、内固定失效率、影像学参数及ODI评分。结果B组和C组内固定融合率均低于A组(P<0.05);3组固定失效率比较,差异无统计学意义(P>0.05);B组和C组矫正丢失量均多于A组(P<0.05);B组和C组末次随访时伤椎后凸Cobb角均高于A组(P<0.05);3组末次随访ODI评分均少于术前、术后6个月(P<0.05);3组术后6个月和末次随访ODI评分比较,差异无统计学意义(P>0.05)。结论后路手术伤椎椎弓根椎体内植骨、椎板/横突间植骨及小关节翻转植骨用于胸腰椎单椎体爆裂性骨折整体疗效接近,且伤椎椎弓根椎体内植骨椎体高度和后凸矫正维持效果更佳。

Objective To investigate the influence of different bone graft schemes in posterior surgery on clinical efficacy and imaging parameters of patients with thoracolumbar single vertebral burst fracture.Methods The clinical data of 129 patients with thoracolumbar single vertebral burst fracture admitted to our hospital from January 2016 to January 2020 were retrospectively analyzed.According to the treatment plan,they were divided into group A(43 patients),group B(44 patients)and group C(42 patients).Group A underwent vertebral pedicle bone graft,group B underwent vertebral plate/transverse process bone graft,and group C underwent facet joint turnover bone graft.The internal fixation fusion rate,internal fixation failure rate,imaging parameters and ODI scores were compared among the three groups.Results The fusion rate of internal fixation in group B and group C was lower than that in group A(P<0.05).There was no significant difference in the fixed failure rate among the three groups(P>0.05).The loss of correction in group B and group C was more than that in group A(P<0.05).The Cobb angle of kyphosis in group B and group C was higher than that in group A at the last follow-up(P<0.05).The ODI scores of the three groups at the last follow-up were lower than those before operation and 6 months after operation(P<0.05).There was no significant difference in ODI scores between the three groups at 6 months after operation and the last follow-up(P>0.05).Conclusion The overall efficacy of pedicle bone graft,vertebral plate/transverse process bone graft and facet joint turnover bone graft in the treatment of patients with thoracolumbar single vertebral burst fracture is similar,and the vertebral height and kyphosis correction of vertebral pedicle bone grafting are better.