摘要
目的评估纳米人工骨治疗胸腰椎骨折复位后骨缺损的临床疗效。方法2017年2月—2019年3月,收治胸腰椎骨折患者64例,其中32例接受后路钉棒复位纳米人工骨修复骨缺损(观察组),另32例仅接受后路钉棒复位未行纳米人工骨填充(对照组)。记录2组固定节段、手术时间、术中出血量及术后并发症发生情况,测量并比较2组术前、术后3 d及末次随访时各项影像学参数,观察末次随访时2组骨性融合情况。结果所有手术顺利完成,观察组随访12~37个月,对照组随访12~28个月。2组患者固定节段、术中出血量及手术时间差异均无统计学意义(P>0.05)。观察组术后发生脑脊液漏1例,切口愈合不良2例;对照组术后发生切口愈合不良1例。2组术后3 d及末次随访时局部后凸角、骨折椎体楔形角低于术前,骨折椎体前缘高度高于术前,椎管占位率低于术前,差异均有统计学意义(P<0.05)。观察组术后3 d骨缺损率低于对照组,差异有统计学意义(P<0.05)。末次随访时,观察组骨折椎体楔形角小于对照组,骨折椎体前缘高度高于对照组,差异均有统计学意义(P<0.05)。末次随访时观察组植骨均融合,对照组14例椎体内骨缺损仍存在。结论术中三维CT是评估胸腰椎骨折复位后骨缺损的一种简单有效的影像学手段。对于存在骨缺损者,使用后路椎弓根钉棒系统复位固定联合纳米人工骨修复骨缺损可获得良好的临床疗效。
Objective To evaluate the clinical effect of nano-artificial bone for bone defect after reduction for thoracolumbar fracture(TLF).Methods From February 2017 to March 2019,64 patients with thoracolumbar fractures were treated,of which 32 patients received posterior screw rod reduction and repair of bone defects with nano-artificial bone(observation group),and the other 32 patients only received posterior screw rod reduction without nano-artificial bone filling(control group).Operative data including fusion levels,operation time,intraoperative blood loss and complications were recorded.The preoperative,postoperative 3 d and final follow-up radiographic parameters were recorded and further compared between the 2 groups.The bone fusion of the 2 groups was observed at the final follow-up.Results All the operations were successfully completed.The observation group was followed up for 12-37 months and the control group for 12-28 months.There was no significant difference in fusion levels,intraoperative blood loss and operation time between the 2 groups(P>0.05).Cerebrospinal fluid leakage occurred in 1 case and poor wound healing in 2 in the observation group,and poor wound healing occurred in 1 in the control group.The local kyphosis angle and vertebral wedging angle at postoperative 3 d and final follow-up,and canal occupying rate at postoperative 3 d in the 2 groups were lower than those before operation,and the anterior edge height of injured vertebrae at postoperative 3 d and final follow-up was higher than that before operation,all with a significant difference(P<0.05).The bone defect rate at postoperative 3 d was significantly lower in the observation group than in the control group,and the difference was statistically significant(P<0.05).The observation group was found to have obviously decreased vertebral wedging angle and increased anterior edge height of injured vertebrae than the control group at the final follow-up,all with a significant difference(P<0.05).Furthermore,all the patients got solid bony fusion in the observation group,while bone defect still existed in 14 patients in the control group at the final follow-up.Conclusions Intraoperative 3D-CT is a simple and effective method for evaluating bone defect after reduction of TLF.Posterior pedicle screws with nano-artificial bone can provide satisfactory clinical outcomes in TLF patients with bone defect.
作者
周波
王强
蒋俊锋
钱玉强
陈亮
杨斐
张行
江龙
Zhou Bo;Wang Qiang;Jiang Junfeng;Qian Yuqiang;Chen Liang;Yang Fei;Zhang Xing;Jiang Long(Department of Orthopaedics,Yixing People’s Hospital,Yixing 214200,Jiangsu,China)
出处
《脊柱外科杂志》
2022年第1期10-15,共6页
Journal of Spinal Surgery
基金
无锡市卫生健康委科研项目(Q202060)。
关键词
胸椎
腰椎
脊柱骨折
骨代用品
内固定器
Thoracic vertebrae
Lumbar vertebrae
Spinal fractures
Bone substitutes
Internal fixators
