Pedicle screw fixation combined with artificial bone graft improves bone formation after thoracolumbar fractures

doi:10.3969/j.issn.2095-4344.2015.16.001

Abstract

Abstract:

BACKGROUND: Simple pedicle screw fixation for thoracolumbar fractures has better outcomes, but there are some deficiencies, such as poor applicability for severe compression or burst fractures, strong vertebral pain, easy to cause vertebral wound denervation and paraspinal muscle injury, and slow recovery.
OBJECTIVE: To investigate the clinical effects of pedicle screw fixation combined with artificial bone graft for the treatment of thoracolumbar fractures.
METHODS: A total of 126 patients with thoracolumbar vertebral compression fractures, who had undergone pedicle screw fixation without bone graft (control group, n=62) and with bone graft (test group, n=64) were enrolled. The fracture healing, anterior vertebral height ratio, sagittal Cobb angle, and loss rate of vertebral height after 6 months were observed by X-ray in the two groups.
RESULTS AND CONCLUSION: All patients were followed up, and had complete fracture healing after 12-16 months. The anterior vertebral height and Cobb angle were both improved in the two groups at 1 week after operation (P < 0.01), but there was no difference between the two groups (P > 0.05). New bone formation was observed in the test group at 6 months after operation, and patients were pain-free; but the speed of bone formation was slower in the control group, and patients still suffered from painful thoracolumbar fractures. There was no difference in the loss of anterior vertebral height and Cobb angle between the two groups (P > 0.05). These findings indicate that pedicle screw fixation combined with artificial bone graft lead to a better recovery in thoracolumbar fractures.

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

全文链接：

Key words: Spinal Fractures, Fractures, Compression, Lumbar Vertebrae, Thoracic Vertebrae, Internal Fixators

CLC Number:

R318

Ren Yong-an, Yu Sheng-hui, Gu Zu-chao, Zhang Yu, Peng Yin-xiao, Chen Xin, Gao Wei-qiang. Pedicle screw fixation combined with artificial bone graft improves bone formation after thoracolumbar fractures[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(16): 2461-2466.

Figures/Tables 3

2.1 参与者数量分析两组患者均顺利完成手术治疗，均未出现出院失访情况，总随访时间为6-16个月。 2.2 两组基线资料比较两组在性别比例、年龄结构、体型等方面的差异无显著性意义(P > 0.05)，资料具有较强可比性，见表1。 2.3 围术期参数及住院时间比较试验组手术时间、失血量、引流量稍高于对照组，但差异无显著性意义(P > 0.05)；试验组住院时间短于对照组(P < 0.01)，见表2。 2.4 随访观察骨折愈合及椎体高度丢失两组患者均获得随访，修复后1周及6个月至少各拍摄1次X射线片，总随访时间为6-16个月。修复6个月后，两组骨折愈合情况良好，其中对照组伤椎高度维持较好，但新骨生成较缓慢，患者伤椎仍有痛感；试验组人工骨完全吸收，伤椎高度维持良好，可见新骨生成，患者伤椎无明显痛感。修复后12-16个月，两组骨折椎体愈合完全，取出固定螺钉，椎体高度均无明显丢失，两组骨折痊愈时间比较差异无显著性意义(P > 0.05)。 2.5 椎体前缘高度百分比比较两组修复前的椎体前缘高度百分比比较差异无显著性意义(t=0.436，P > 0.05)；修复后1周，两组间椎体前缘高度百分比比较差异无显著性意义(t=1.132，P > 0.05)，但均优于修复前(P < 0.01)；修复后6个月，两组间椎体高度丢失率比较差异无显著性意义(t=0.664，P > 0.05)，见表3。 2.6 矢状位Cobb角比较两组修复前的矢状位Cobb角比较差异无显著性意义(t=0.435，P > 0.05)；修复后1周，两组矢状位Cobb角比较差异无显著性意义(t=0.233， P，但均优于修复前(P < 0.01)；修复后6个月，两组矢状位Cobb角比较差异无显著性意义(t=0.227，P > 0.05)，见表4。 > 0.05) 2.7 不良反应对照组3例因创面出现积液延期愈合，其余患者伤口Ⅰ期愈合。试验组未发生与人工骨复合物相关的不良反应。 2.8 典型病例 34岁男性患者，2012年5月因高处坠落致椎体骨折，受伤后第5天接受手术治疗。根据患者病情结合患者意愿，选择伤椎置钉并植入人工骨复合物疗法治疗，治疗方案经医院伦理委员会核准。修复前检查表明，患者T12节段爆裂性骨折(图1A，B)；通过伤椎置钉并植入人工骨复合物后1周，可见伤椎创面人工骨填充理想，凝固成形状态维持良好，未出现渗漏(图1C，D)；修复后6个月，患者椎体高度维持良好，伤椎创面显影表明人工骨已基本吸收完全，创面可见明显新骨组织生成(图1E，F)，患者伤椎位置感觉正常，已无明显痛感；修复后12个月，骨折愈合，取出内固定螺钉，椎体高度未见明显丢失。"

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