摘要
[目的]探讨经椎弓根植骨椎体成形结合椎弓根钉固定治疗胸腰椎骨折的远期疗效。[方法]回顾2003年3月-2008年6月经椎弓根自体骨混合(Osteoset)人工骨植骨椎体成形结合椎弓根钉固定治疗胸腰椎骨折并获得平均3年随访的38例患者,对其影像学、神经功能和临床症状进行评价。评价标准:(1)影像学评价:包括椎体压缩率、椎管侵占率及脊柱矢状面Cobb′s角的恢复。采用多个样本均数间的两两比较,SNK-q检验方法进行统计学分析;(2)神经功能和临床评价:按美国脊髓损伤协会(ASIS)分级标准进行分级,26例合并神经损伤,ASIS分级提高1级为改善。[结果]本组获得随访的38例患者,优良率达87%,患者均在术后2～3周早期离床活动,无断钉、断棒、椎体再压缩等并发症。术后椎体高度及生理弧度恢复满意,无1例出现神经症状加重。33例患者椎体骨折基本达到解剖复位,远期复查椎体高度无丢失情况。[结论]自体骨混合(Osteoset)人工骨植骨椎体成形结合椎弓根钉固定治疗胸腰椎骨折有良好的复位和固定作用,可有效的消除伤椎的"蛋壳"效应,能即时增加椎体的骨容量和脊柱前柱的抗压稳定性,使病人能早期活动,减少内固定物因应力过大造成的断钉、断棒、椎体再压缩等并发症,效果满意,值得临床应用。
[ Objective] To analyze the long term effect after treatment of thoracolumbar vertebral fracture with trans-pedicle bone fusion vertebroplasty and screw fixation. [ Method ] From March 2003 to June 2008,38 cases of thoracolumbar fractures were treated with autogenous and allogenic （Osteoset） bone fusion vertebroplasty and screw fixation. All patients were followed up for an average of 3 years and fluoroscopy, neoropathic-function and clinical symptom were analyzed. The evaluation cr＇.＇teria were ： I. Fluoroscopy included packing ratio of vertebral body,invasion ratio of vertebral canal, and Cobbg angle of spinal sagittal plane. SNK-q check of multiple comparison was used as statistical analysis. 2. Neuropathic function and clinical evaluation adopted A- merican Spinal Injury Society（ASIS） classification standard. Twenty-six cases had nerve injuries, their improvement was defined as ASIS grade improvement. [ Result] The good-to-excellent rate reached 87%. All patients began to ambulate 2-3 weeks postop- eratively. No postoperative complications were found such as nails breaking, shaft breaking and second vertebral body compres- sion. The body height and physiological curve recovered satisfactorily. All fractures reached anatomical reduction and no loss of vertebral height was found in the long-term follow-up. [ Conclusion ] Treatment of thoracolumbar fracture with autogenous and al- logenic （Osteoset） bone fusion vertebroplasty-and screw fixation is effective and can eliminate the effect of ＂ eggshell＂, and can increase the capacity of vertebral body and stability of the spine. Patients could do exercises earlier with less possibility of nail breaking and shaft breaking or other complications. It is worth of clinical application.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2009年第12期887-890,共4页
Orthopedic Journal of China
