经伤椎椎弓根植骨和单纯后外侧植骨治疗胸腰椎骨折的疗效对比研究

目的 比较经伤椎椎弓根行椎体内植骨与单纯后外侧植骨两种方法 在椎弓根内固定系统复位固定治疗胸腰椎骨折疗效方面的差异.方法 对2004 年7 月至2007 年7 月沧州市中心医院采用椎弓根内固定系统复位固定治疗的186 例胸腰椎骨折患者的临床资料进行回顾性分析,其中经伤椎椎弓根椎体内植骨（经椎弓根植骨组）100 例,单纯后外侧植骨（单纯植骨组）86 例.对两组患者术后椎体压缩率、临床症状改善情况、并发症等方面进行比较.结果 两组患者均获随访.经椎弓根植骨组随访时间24～30 个月,平均随访时间28.4 个月;单纯植骨组随访时间24～38 个月,平均随访时间28.0 个月.经椎弓根植骨组患者术前、术后即刻和术后18 个月随访时的椎体压缩率分别为（38.2 ± 16.1）%、（2.4 ± 1.7）%和（3.7 ± 1.6）%,3 个时相点比较,差异有统计学意义（P ＜0.05）;单纯植骨组患者术前、术后即刻和术后18 个月随访时的椎体压缩率分别为（37.3 ± 13.8）%、（9.8± 5.3）%和（18.4 ± 8.7）%,3 个时相点比较,差异有统计学意义（P ＜0.05）.两组患者术前椎体压缩率比较,差异无统计学意义（P ＞0.05）;经椎弓根植骨组患者在术后即刻、术后随访18 个月时椎体压缩率均小于单纯植骨组（P ＜0.05）.两组术前有神经症状的患者术后腰部疼痛均明显缓解.术后18 个月随访时经椎弓根植骨组未出现断钉、断棒或松动;单纯植骨组有2 例出现内固定断裂.同期的CT扫描显示,经椎弓根植骨组椎体内植骨未吸收,填充确实,有4 例伤椎椎弓根破裂增粗,但未出现明显根性症状;单纯植骨组均可见椎体内空洞.结论 经伤椎椎弓根行椎体内植骨结合椎弓根内固定治疗胸腰椎骨折可即时恢复并长期维持椎体高度,降低内固定松动、断裂等并发症的发生率,临床效果理想.

A comparative study on the treatment of thoracolumbar fractures between transpedicular intracorporeal grafting and transposterolateral grafting

Objective To compare the clinical effects of two methods of transpedicular intracorporeal grafting and transposterolateral grafting in the treatment of thoracolumbar fractures with pedicle screw fixationsystem.Methods From July 2004 to July 2007,186 patients of thoracolumbar fractures were underwent open reduction and pedicle screw fixation at Cangzhou Central Hospital.Among them,100 patients treated with transpedicular intracorporeal grafting(A group),and 86 treated with transposterolateral grafting(B group).The vertebral compression rate,the improvement of clinical symptoms and postoperative complications were compared between two groups.Results In A group,patients were followed up from 24 to 30 months,with the average of 28.4 months;in B group,patients were followed up from 24 to 38 months with the average of 28.0 months.The vertebral compression rate at preoperation,postoperation and 18 months after operation was(38.2± 16.1)%,(2.4±1.7)%,and(3.7±1.6)%respectively in A group,the differences among them had statistical significance(P<0.05);the vertebral compression rate at preoperation,postoperation and 18 months after operation was(37.3±13.8)%,(9.8±5.3)%and(18.4±8.7)%respectively in B group,the differences among them had statistical significance(P<0.05).Between A and B groups,the preoperative vertebral compression rate was similar(P>0.05),while the vertebral compression rate at postoperation as well as 18 months after the surgery in A group were lower than those in B group(P<0.05).During the follow-up,all patients who had neurological symptoms before the surgery got relieved obviously.At 18 months after the surgery,there was no screw or rod broken,and no fixation loosening in A group,while in B group,there had internal fixation broken in 2 cases.At the same time,CT scan results showed that intracorporeal graft had stuffed completely,and not been absorbed in A group,with 4 cases of pedicular broken and thicken but none of them had obvious radicular symptoms;In B group,we could see vertebral cavity in all patients.Conclusion For thoracolumbar fractures, transpedicular intracoporeal grafting based on pedicle fixation can get ideal clinical effects because it can restore vertebral height instantly and maintain the height during a long term,and it also can decrease the incidence of complications such as internal fixation loosening or rupture.