Pedicle screw fixation combined with posterior-lateral fusion with autogenous bone for thoracolumbar burst fractures

doi:10.3969/j.issn.2095-4344.2017.15.009

Abstract

Abstract:

BACKGROUND: Spinal reconstruction plays an important role in the treatment of thoracolumbar burst fractures, but wherther the vertebral fusion can effectively reduce the loss of correction still remains controversial.

OBJECTIVE: To investigate the repair effect of pedicle screw fixation combined with posterior-lateral fusion with autogenous bone for thoracolumbar burst fractures.

METHODS: Eighty patients with thoracolumbar burst fractures undergoing pedicle screw fixation from January 2011 to June 2015 were enrolled, and were then randomly divided into experimental (posterior-lateral fusion with autogenous bone) and control groups (n=40 per group). The clinical efficacy was assessed according to the operation time, intraoperative blood loss and postoperative drainage volume, wound scale scores, anterior vertebral height and Cobb angle, American Spinal Injury Association impairment scale, and Oswestry dysfunction index.

RESULTS AND CONCLUSION: (1) All patients were followed up for 24 months. The operation time, intraoperative blood loss and postoperative drainage volum in the experimental group were significantly more than those in the control group (P < 0.05). (2) The anterior vertebral height and Cobb angle were significantly improved in both two groups (P < 0.01), and there was slight loss in vertebral height and Cobb angle in both two groups durring follow-up, but showed no significant difference between two groups (P > 0.05). (3) The American Spinal Injury Association impairment scale and Oswestry dysfunction index scores were significantly improved in the two groups, but had no significant difference between two groups (P > 0.05). (4) These results suggest that pedicle screw internal fixation is effective and safe for thoracolumbar burst fractures. Posterior-lateral fusion with autogenous bone allograft holds a good histocompatibility, but cannot reduce postoperative correction loss, therefore, it is not recommended for vertebral burst fractures.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Thoratic Vertebrae, Lumbar Vertebrae, Fractures, Bone, Internal Fixators, Bone Transplantation, Tissue Engineering

CLC Number:

R318

Dong You-jun, Wu Liang, Wu Guo-feng, Zhou Jian, Wang Kun, Sun Han, Sun Xiao-liang. Pedicle screw fixation combined with posterior-lateral fusion with autogenous bone for thoracolumbar burst fractures [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(15): 2342-2348.

Figures/Tables 2

2.2 基线资料比较植骨组男女性别比、年龄以及减压情况与非植骨组相比差异均无显著性意义(P > 0.05)；植骨组的伤椎节段与非植骨组相比差异无显著性意义(P=0.828>0.05)。综上所述，2组基线资料比较差异无显著性意义，具有可比性，见表1。 2.3 手术情况对比通过临床观察，植骨组40例患者的手术时间、术中出血量以及术后引流量均大于非植骨组(P < 0.05)，2组患者伤口局部情况术后3 d后得到明显改善(P < 0.05)，但在术后3 d、1周、2周的时间段内，2组患者之间差异并无显著性意义(P > 0.05)，见表2。 2.4 脊髓损伤ASIA神经功能分级变化植骨组患者术前分级A级19例、B级12例、C级4例、D级2例、E级3例，术后改善到A级0例、B级0例、C级3例、D级1例、E级36例；而非植骨组患者术前分级A级17例、B级16例、C级3例、D级3例、E级1例，术后改善为A级0例、B级1例、C级2例、D级1例、E级35例。2组患者神经功能均明显改善，但2组间差异无显著性意义，见表3。 2.5 术后随访对比与术前相比，植骨组与非植骨组患者术后随访过程中椎体高度、Cobb角均有显著改善(P < 0.01)，椎体高度矫正率分别为45%，41%；Cobb角矫正率为65%，29%；但术后随访过程中椎体高度、Cobb角均有轻度丢失，椎体高度丢失4%，4%；Cobb角丢失32%，21%，2组患者之间对比差异仍无显著性意义(P=0.741)。根据Steinman脊椎融合标准，植骨组术后12周左右植骨椎体后外侧均出现融合，大部分移植骨被新骨代替，16周左右评分均达到满分4分，植骨椎体100%全部融合。Oswestry功能障碍指数结果表明，与术前相比2组患者术后运动功能障碍有显著好转，且随着时间推移，功能恢复进一步改善(P < 0.01)，但植骨与否并未对此评分有明显影响(P > 0.05)，见表4。 2.6 典型病例女性患者，41岁，因车祸摔伤致腰背部疼痛、活动受限2 h入院，根据病史、查体及相关影像资料检查，诊断为L1椎体爆裂性骨折。治疗方案：腰椎后路减压术+腰椎后路内固定+椎体后外侧植骨融合术。随访24个月，结果显示患者术后椎体高度及Cobb角较术前明显改善，且末次随访植骨部位已全部融合，椎体高度及Cobb角仅有轻度丢失，无不良事件发生，见图2。 2.7 不良事件所有随访病例均无不良事件发生，同种异体骨与人体组织有较好的相容性，安全性等级为Ⅰ级。"

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