后路椎弓根钉棒复位内固定+经伤椎椎弓根植骨治疗胸腰椎
骨折
曹杰;于海洋;梁成民;焦伟
【期刊名称】《中国骨与关节外科》 【年(卷),期】2016(009)005
【摘要】背景:胸腰椎骨折临床上常见,传统手术方案是后路椎弓根钉棒复位内固定+自体髂骨植骨,但术后胸腰段活动度受影响,且远期伤椎椎体前部仍会有椎体体积25%大小的骨缺损,即所谓的\蛋壳\效应,导致远期伤椎局部后凸再次增大、矫正丢失等并发症.后路椎弓根钉棒复位内固定+经伤椎椎弓根植骨可恢复椎体前中柱的抗压性,因而备受关注.目的:探讨后路椎弓根钉棒复位内固定+经伤椎椎弓根植骨治疗胸腰椎骨折的临床疗效.方法:2014年1月至2016年1月收治无需减压的胸腰椎骨折患者42例,男31例,女11例;年龄20~52岁,平均37.3±1.2岁;按Denis分型:DenisⅠ型(压缩型)31例,Ⅱ型(爆裂型)11例.分为2组,伤椎椎体后壁完整入选非融合组,后壁破损入选融合组,非融合组21例后路椎弓根钉棒复位内固定后在\型臂X线机透视引导下应用硫酸钙经伤椎椎弓根椎体内植骨治疗;融合组21例后路椎弓根钉棒复位内固定后取髂骨植骨融合治疗.比较两组患者的临床参数和影像学指标.结果:2组患者均顺利完成手术,术中未发生大出血、损伤神经等手术并发症,获得12~36个月随访,平均(23.5±1.8)个月.非融合组的术后胸腰段Cobb角(过屈位/过伸位)比值优于融合组(P<0.05),非融合组伤椎椎体的骨容量优于融合组,且非融合组术后伤椎均未出现\蛋壳\效应.结论:后路椎弓根钉棒复位内固定+经伤椎椎弓根植骨治疗胸腰椎骨折手术安全可靠,矫正效果满意,术后恢复快,不影响腰椎活动度,并有效防止伤椎出现\蛋壳
\效应,能即时增加伤椎椎体的骨容量及前柱的抗压稳定性.ockground:Thoracolumbar fractures are common in clinic. The traditional operation scheme is posterior pedi-cle screw reduction and internal fixation plus iliac bone grafting, but thoracolumbar range of motion may be affected and there is still bone defect in anterior involved vertebrae. Some complications, such as kyphosis and correction loss will oc-curred in long term. Objective:To investigate clinical outcomes of nonfusion transpedicle bone grafting and screw fixation for thoracolumbar vertebral fracture. Methods:Totally 42 patients with thoracolumbar vertebral fracture admitted to our hos-pital from January 2014 to January 2016 were enrolled in this study. There were 31 males and 11 females with a mean age of (37.3±1.2) years (range, 20-52 years). There are 31 cases of Denis typeⅠand 11 cases of Denis typeⅡ. They were di-vided into fusion group and non-fusion group according to the intactness of back wall of injured vertebrae (n=21). Transped-icle bone grafting using injectable calcium sulfate cement (CSC) was performed in the non-fusion group. Posterior pedicle screw reduction and internal fixation plus iliac bone grafting was conducted in the fusion group. Results:All the patients were operated successfully, with no complications such as bleeding, nerve injury. The mean duration of follow-up was (23.5±1.8) months (range, 12-36 months).
The
ratio
of
thoracolumbar
Cobb
angle
(over
bending/hyperextension) in the non-fusion group was superior to that in the fusion group (P<0.05). The effect of\the postoperative wound in the non-fusion group. Conclusions:The transpedicle bone grafting and screw fixation is a safe and reliable method for thoracolumbar vertebral fracture. It can provide satisfied correction, fast recovery, but does not affect the lumbar motion. It can effectively prevent the effect of\the injured vertebral body and compressive stability of the anterior column.
【总页数】5页(381-385)
【关键词】脊柱骨折;内固定器;骨移植 【作者】曹杰;于海洋;梁成民;焦伟
【作者单位】阜阳市人民医院骨科脊柱病区,安徽阜阳236000;阜阳市人民医院骨科脊柱病区,安徽阜阳236000;阜阳市人民医院骨科脊柱病区,安徽阜阳236000;阜阳市人民医院骨科脊柱病区,安徽阜阳236000 【正文语种】中文 【中图分类】 【文献来源】
https://www.zhangqiaokeyan.com/academic-journal-cn_chinese-journal-bone-joint-surgery_thesis/0201233868497.html 【相关文献】
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后路椎弓根钉棒复位内固定+经伤椎椎弓根植骨治疗胸腰椎骨折
