摘要
目的探讨后路经椎弓根内固定联合同种异体骨移植治疗胸腰椎骨折的效果。方法2006年9月-2008年3月,采用后路经椎弓根复位内固定方法治疗105例胸腰椎骨折患者,同时将咬除的棘突、椎板骨质与同种异体骨混合行小关节突及横突间植骨或椎板间植骨。男75例,女30例;年龄15～65岁,平均37岁。受伤至手术时间8h～21d,平均3d。致伤原因:高处坠落伤52例,交通伤35例,砸伤11例,跌伤7例。骨折类型按照Mcaffee分型:屈曲压缩型7例,爆裂型86例,Chance骨折9例,骨折脱位型3例。神经功能采用Frankel分级:A级11例,B级2例,C级7例,D级10例,E级75例。患者X线片检查均示伤椎椎体呈压缩楔形改变,CT检查示98例椎管狭窄。术后摄X线正侧位片,评估内固定及植骨融合情况,并测量Cobb角。采用Frankel分级系统评估神经功能恢复情况。结果手术时间55～180min,平均90min。术中出血100～900mL,平均200mL。患者切口均Ⅰ期愈合,术后无并发症发生。93例获随访,随访时间6～15个月,平均11个月。11例Frankel分级为A级的患者无改善,余患者均获1～2级恢复。损伤节段后凸平均Cobb角由术前32.1°恢复至术后5.2°。伤椎椎体前缘高度由术前平均压缩剩余高度61.5%恢复至术后平均96.8%。椎管前后径残留程度由术前平均65.7%恢复至术后89.9%。影像学检查示患者术后6个月内均获骨性愈合,脊柱植骨融合率100%,无螺钉松动、折断。结论后路经椎弓根内固定对胸腰椎骨折具有良好复位和固定作用,自体骨混合同种异体骨移植是一种安全、可靠、有效的方法。
Objective To investigate the e cacy of the pedicle screw xation and allograft bone in posterior spinal fusion for the treatment of thoracolumbar vertebral fractures.Methods From September 2006 to March 2008, 105 cases of thoracolumbar vertebral fractures were treated with allograft bone in posterior spinal fusion after the pedicle screw xation, including 75 males and 30 males aged 15-65 years（mean 37 years）.The mixture which consisted of spinous process and vertebral plate sclerotin and homogeneity variant bone was used as bone graft to implant into articular process and processus transversus space or vertebral plate space.The time from injury to surgery varied from 8 hours to 21 days, with an average of 3 days.There were 52 cases of falling injuries from height, 35 cases of tra c accident injuries, 11 cases of bruise injuries and 7 cases of tumbling injuries.Before operation, the primary clinical symptoms of patients included local pain combined with limitation of activity, 30 cases complicated by various degrees of spinal cord and nerve root functional disturbance.According to Mca ee classi cation, there were 7 cases of exion depressed fractures, 86 cases of blow-out fractures, 9 cases of Chance fractures and 3 cases of dislocation-fracture.According to Frankel grade, there were 11 cases of grade A, 2 cases of grade B, 7 cases of grade C, 10 cases of grade D and 75 cases of grade E.The X-ray examination of all patients denoted that the bodies of injuryed vertebra were compressed and wedge-shaped, and the CT scan showed that 98 cases had spinal stenosis.After 2 weeeks and 3, 6, 12 months, the X-ray lms were taken to evaluate bone graft fusion.The Cobb angle was measured.The recovery of nerve function was analyzed.Results The operation time was 55-180 minutes（mean 90 minutes） and the blood loss was 100-900 mL（mean 200 mL）.All patients achieved healing by rst intention with no complication.After operation, 93 cases were followed up for 6-15 months with an average of 11 months.Except for 11 patients who were at grade A before operation, one to two grade recover was observed in other patients.The average Cobb angle of injury segment was improved from preoperative 32.1° to postoperative 5.2°.The height of anterior border of injuried vertebral body was recovered from the preoperative average compressed remaining height 61.5% to postoperative 96.8%.The vestigial degree of canalis spinalis anteroposterior diameter was recovered from preoperative 65.7% to postoperative 89.9%.Imageology examination showed that all the patient achieved bone union within 6 months.The fusion rate of bone graft in spinal fusion was 100%.No loosening and breaking of nails occurred.Conclusion Pedicle xators can restore and x the thoracolumbar fractures, and the combination of autograft and allograft bone transplantation is a safe, reliable and e ective method.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2009年第5期520-523,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
胸腰椎骨折
椎弓根内固定
同种异体骨移植
自体骨移植
Thoracolumbar vertebral fracture
Pedicle screw fixation
Allogeneic bone transplantation
Autologous bone transplantation
