伤椎体内植骨长斜椎弓钉固定胸腰椎爆裂骨折△

Bone grafting combined with long oblique pedicle screw on the fractured vertebrae in fixation of thoracolumbar burst frac⁃ tures

摘要:

[目的] 探讨伤椎体内植骨长斜椎弓钉固定胸腰椎爆裂骨折的疗效。[方法] 2013 年 2 月—2018 年 2 月本院收治的胸腰椎爆裂骨折患者 42 例，采用伤椎体内植骨、长斜椎弓钉固定、椎板间开窗减压治疗。总结围手术期、随访及影像学资料。[结果]42 例患者均顺利完成手术，无严重并发症。随访(22.45±1.45)个月。随时间推移，患者 VAS 和 ODI 评分显著降低 (P＜0.05)。ASIA 分级，术前 B 级 12 例恢复至末次随访时 E 级 8 例和 D 级 4 例；术前 C 级 30 例均恢复至 E 级 (P＜0.05)。 影像方面，与术前相比，术后伤椎前缘高度比显著增加(P＜0.05)，而局部后凸 Cobb 角显著减少(P＜0.05)。[结论]伤椎体内植骨长斜椎弓钉固定胸腰椎爆裂骨折能改善神经功能，重建伤椎高度，减少迟发性后凸畸形，有效维持矫正效果。

关键词:胸腰椎骨折;斜向置钉;长螺钉;空壳现象;植骨

Abstract:

[Objective] To investigate the clinical outcomes of bone grafting combined with long oblique pedicle screw on the injured vertebrae in pedicle screw fixation of thoracolumbar burst fractures. [Methods] From February 2013 to February 2018, 42 patients under- went abovementioned surgical treatment for thoracolumbar burst fracture in our hospital. The perioperative, follow- up and imaging data were summarized. [Results] All the 42 patients were successfully operated on without serious complications. As time went during the fol- low-up lasted for (22.45±1.45) months, the VAS and ODI scores were significantly decreased (P<0.05) . In term of ASIA grade for neurolog- ical function, of the 12 cases who were grade B before operation, 8 cases improved to grade E and 4 cases to grade D at the latest follow-up, while all the 30 cases who were marked as grade C preoperatively recovered to grade E at the latest follow up (P<0.05) . Radiographically, the ratio of anterior height of injured vertebrae significantly increased (P<0.05) , while the local kyphotic Cobb's angle significantly de- creased postoperatively compared with those preoperatively (P<0.05) . [Conclusion] This bone grafting combined long oblique pedicle screw on the injured vertebrae in pedicle screw fixation of thoracolumbar burst fractures does improve nerve function, reconstruct the height of injured vertebrae, reduce residual kyphosis and maintain the correction effectively.

Key words:thoracolumbar fracture; oblique screw placement; long screw; vacuum phenomenon; bone grafting