摘要
目的比较胸腰椎爆裂性骨折后路手术中三种不同植骨方式的疗效。方法回顾性分析2013年3月至2015年3月佛山市中医院骨1科收治采用后路短节段固定治疗的258例胸腰椎单椎体爆裂性骨折患者资料,根据植骨方式不同分为3组:A组经伤椎椎弓根椎体内植骨87例,B组椎板及横突间植骨87例,C组小关节翻转植骨84例;术后比较三组患者的脊柱矢状面后凸cobb角、矫正度丢失、骨性融合率、内固定失效情况、Oswestry功能障碍指数(ODI)评价。结果三组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。三组患者术后1周(4.9°±1.0°、4.8°±0.6°、4.8°±0.6°)和末次随访时(6.1°±1.5°、14.5°±3.7°、15.3°±4.1°)的后凸cobb角均低于术前(27.5°±4.9°、27.6°±4.6°、27.6°±4.2°),差异有统计学意义(P<0.05);B、C组末次随访时的后凸cobb角均大于术后1周,差异有统计学意义(P<0.05)。末次随访时B、C组的后凸cobb角及后凸cobb角矫正度丢失比例均大于A组,差异有统计学意义(P<0.05)。A组骨性融合率(100.0%)高于B(80.5%)、C组(76.2%),差异均有统计学意义(P<0.05);三组间内固定失效率(0、1.1%、2.4%)比较差异无统计学意义(χ2=2.108,P=0.348)。三组患者的ODI术后6个月[(28.5±4.1)、(28.7±3.9)、(28.8±3.7)分]、末次随访时[(10.7±2.6)、(11.0±2.7)、(11.4±3.1)分]均比术前[(94.3±0.7)、(94.4±0.9)、(94.4±0.8)分]下降,差异有统计学意义(P<0.001);所有患者末次随访时ODI均低于术后6个月,差异有统计学意义(P<0.001)。结论后路联合经椎弓根椎体内植骨、后外侧植骨、翻转植骨结合短节段内固定治疗胸腰椎骨折植骨融合率高,能有效恢复椎体高度。后两种植骨方式均虽能达到良好效果,但远期椎体高度丢失率及后凸矫正度丢失率较高。
Objective To compare and the advantages and disadvantages of 3 methods of bone grafting in the posterior treatment of thoracolumbar burst fracture. Methods A retrospective analysis was conducted of 258 thoracolumbar burst fractures treated with posterior short-segment fixation from March 2013 to March 2015 at Orthopedic Department One, Foshan Hospital of Traditional Chinese Medicine. Of them, 87 were treated with transpedicular bone grafting (group A), 87 with laminar and intertransverse process bone grafting (group B) and 84 with small joint turnover plus bone grafting (group C). The 3 groups were compared in terms of cobb angle, loss of correction, bony fusion, internal fixation failure, and Oswestry disability index (ODI). Results The 3 groups were comparable due to insignificant differences in the preoperative general data between them (P>0.05). The cobb angles in the 3 groups at one week after operation (4.9°±1.0°, 4.8°±0.6° and 4.8°±0.6°) and at the final follow-up (6.1°±1.5°, 14.5°±3.7° and 15.3°±4.1°) were significantly smaller than those before operation (27.5°±4.9°, 27.6°±4.6° and 27.6°±4.2°)(P<0.05). The cobb angles in groups B and C at the final follow-up were significantly larger than those at one week after operation (P<0.05). At the final follow-up, both the cob angles and the loss of kyphoplasty correction in groups B and C were significantly larger than in group A (P<0.05). The fusion rate in group A (100%) was significantly larger than in group B (80.5%) and C (76.2%). There were no significant differences between the 3 groups in the rate of internal fixation failure (0, 1.1% and 2.4%)(χ2=2.108, P=0.348). The ODI for the 3 groups at 6 months after operation (28.5±4.1, 28.7±3.9 and 28.8±3.7) and at the final follow-up (10.7±2.6, 11.0±2.7 and 11.4±3.1) were all significantly lower than the preoperative values (94.3±0.7, 94.4±0.9 and 94.4±0.8)(P<0.001). In all the patients, the ODI at the final follow-up was significantly lower than that at 6 months after operation(P<0.001). Conclusions In the treatment of thoracolumbar burst fractures, all the posterior approach plus transpedicular bone grafting, posterolateral bone grafting and reversed bone grafting plus short segmental internal fixation can effectively restore vertebral height and result in a high rate of fusion. Although the latter 2 methods of bone grafting are effective, they may be disadvantageous in leading to long-term loss of vertebral height and kyphosis correction.
作者
付忠泉
禤天航
霍智铭
曹正霖
关宏刚
Fu Zhongquan;Xuan Tianhang;Huo Zhiming;Cao Zhenglin;Guan Honggang(Orthopedic Department One, Foshan Hospital of Traditional Chinese Medicine, Foshan 528000, Guangdong, China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2019年第7期623-627,共5页
Chinese Journal of Orthopaedic Trauma
关键词
胸椎
腰椎
骨折
植骨
Thoracic vertebrae
Lumbar vertebrae
Fractures, bone
Bone graft
