中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (26): 4911-4914.doi: 10.3969/j.issn.1673-8225.2010.26.040

• 骨与关节学术探讨 academic discussion of the bone and joint • 上一篇    下一篇

短节段椎弓根钉置入内固定结合自体颗粒骨椎体成形治疗胸腰椎爆裂骨折：33例随访结果评价

刘  平，徐宏光，王  弘，杨晓明，丁国正   

  1. 皖南医学院弋矶山医院骨二科，安徽省芜湖市241001
  • 出版日期:2010-06-25 发布日期:2010-06-25
  • 通讯作者: 徐宏光，教授，皖南医学院弋矶山医院骨二科，安徽省芜湖市 241001 xuhg@medmail. com.cn
  • 作者简介:刘 平，男，1963年，安徽省芜湖市人，汉族，1988年武汉同济医科大学毕业，副主任医师，主要从事脊柱外科及老年骨病的研究。 liupingyjs@ 163.com
  • 基金资助:

    国家自然基金项目(30973025)

Short-segment transpedicular screw internal fixation combined with vertebroplasty of autologous granular bones in treatment of thoracolumbar burst fractures: A follow-up evaluation of 33 cases

Liu Ping, Xu Hong-guang, Wang Hong, Yang Xiao-ming, Ding Guo-zheng   

  1. Second Department of Orthopedic Surgery, Yijishan Hospital, Wannan Medical College, Wuhu  241001, Anhui Province, China
  • Online:2010-06-25 Published:2010-06-25
  • Contact: Xu Hong-guang, Professor, Second Department of Orthopedic Surgery, Yijishan Hospital, Wannan Medical College, Wuhu 241001, Anhui Province, China xuhg@medmail. com.cn
  • About author:Liu Ping, Associate chief physician, Second Department of Orthopedic Surgery, Yijishan Hospital, Wannan Medical College, Wuhu 241001, Anhui Province, China liupingyjs@163.com
  • Supported by:

    the National Natural Science Foundation of China, No. 30973025*

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摘要：

背景：短节段椎弓根钉系统置入内固定是治疗脊柱胸腰段爆裂骨折的重要方法之一。但由于椎体复位过程中，形成了椎体内空隙即蛋壳样椎体，使前中柱丧失了结构上的完整性，如不进行有效的植骨重建，则有可能出现内固定物失效及矫正度丢失等并发症。

目的：探讨短节段椎弓根钉置入复位固定结合自体颗粒骨椎体成形治疗胸腰椎爆裂骨折的方法及临床效果。

方法：采用椎弓根钉棒系统对伤椎进行置入复位后，经过伤椎椎弓根植入自体颗粒骨治疗胸腰椎爆裂骨折33 例，治疗前后行 X 射线摄片观察骨折椎体前后缘及椎体中央高度压缩率变化，Cobb角改善情况及并发症发生情况。

结果与结论：置入后末次随访测得椎体前后缘、中央高度压缩率及 Cobb角，与术前相比差异均明显降低(P < 0.05)；而与术后即刻相比差异无显著性意义( P > 0.05)。29例脊髓神经不完全损伤患者，按美国脊髓损伤协会标准评定，置入后神经功能均有(≥1级)恢复，伤椎椎体高度恢复并维持良好，无植骨操作引起的神经血管并发症。结果说明采用椎弓根螺钉系统复位内固定结合自体颗粒骨椎体成形治疗胸腰椎爆裂骨折，能恢复椎体高度及强度，改善椎体经终板塌陷的复位效果，减少置入后矫正丢失并提高脊柱的稳定性。

关键词: 胸腰椎骨折, 内固定, 椎体成形, 自体骨, 椎弓根钉, 骨科植入物

Abstract:

BACKGROUND: Short-segment transpedicular screw internal fixation is one of the important methods in treating thoracolumbar burst fracture. However, the formation of intravertebral void during vertebrae reduction and lost of structure integrality of anterior and middle columns lead to fixation failure or correction loss if no effective bone grafting. 

OBJECTIVE: To study the methods and long term results of transpedicular screw internal fixation combined with vertebral plasty of pellet autos bones in treatment of thoracolumbar spine fracture.

METHODS: Thirty-three patients with thoracolumbar spine fracture were treated with short-segmental transpedicalar screw internal fixation combined with vertebral plasty of pellet autos bones. X-ray examinations were done preoperatively. The change of compressed ratios of the anterior and posterior edges of vertebral body and the middle heights of the injured vertebra, as well as the improved Cobb angle were observed respectively.

RESULTS AND CONCLUSION: The mean value of anterior compressed ratios, middle heights compressed ratios and Cobb angle were obviously decreased postoperatively than that of preoperatively (P < 0.05), which had no statistical significance compared with immediately after operation (P > 0.05). According to standard of American Spinal Cord Injury Association, the nerve function of 29 cases with incomplete spinal cord injuries reached grade 1 recovery after operation. Related complications were found in all patients. The results demonstrated that transpedicular screw internal fixation combined with vertebral plasty of pellet autos bones can restore the height and strength of vertebral body, improve the reduction effect of vertebral endplate, decrease correction loss, as well as elevate spinal stability.

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