骨经椎弓根椎体内外植骨融合内固定治疗胸腰椎骨折.pdf

中国骨与关节损伤杂志2008年9月第23卷第9期·711·

·论著·

颗粒骨经椎弓根椎体内外植骨融合内固定治疗
胸腰椎骨折

王金国X吴华X丁晓琳XX刘玉田XX

摘要目的探讨脊柱后路颗粒骨经椎弓根椎体内外植骨短节段椎弓根钉内固定治疗胸腰椎骨折可行性。方法将70例胸腰
椎骨折随机分为两组:A组(n=20)采用颗粒骨经椎弓根椎体内植骨融合短节段椎弓根钉内固定;B组(n=50)采用单纯短
节段椎弓根钉内固定。对后凸畸形角度及矫正角度、椎体前缘高度以及椎管矢状径进行测量,采用Frankel功能分级和Denis
疼痛分级方法进行神经功能改变的评价。结果后凸畸形术后矫正度数较术前两组均很明显。随访中,A组矫正度数的丢失明
显小于B组(P=010001)。术后伤椎前缘高度百分比增加值两组比较有显著差异(P<01001)。术后随访中,A组伤椎椎体前
缘高度无丢失(P<01001),B组伤椎椎体前缘高度有丢失(P<0105)。采用Denis疼痛分级,两组术后均有很好的改善。采
用Frankel功能分级,术后神经功能变化,A组患者平均提高优于B组。结论脊柱后路颗粒骨经椎弓根椎体内外植骨结合内
固定治疗胸腰椎骨折植骨融合率高,能有效恢复椎体高度和防止术后矫正度丢失。
关键词胸腰椎骨折;颗粒骨;植骨融合;椎弓根内固定

TreatmentofThoracolumbarVertebraeFractureswithPosteriorMorselizedBoneGraftinginVertebraeforSpinalFusionandPedicle
ScrewFixation
WangJinguo,WuHua,DingXiaolin,etal.DepartmentofOrthopaedics,TongjiHospital,Tongjimedicalcollege,Huazhong
UniversityofScienceandTechnology,Wuhan,430030
AbstractObjectiveToevaluatetheefficacyofreinforcingshort-segmentpediclescrewfixationwithposteriormorselizedbonegraft2
inginvertebraeforspinalfusioninpatientswiththoracolumbarvertebraefractures.MethodsThe70patientswiththoracolumbarverte2
braefracturesunderwentshort-segmentpediclescrewfixation.FracturesingroupA(n=20)werereinforcedwithposteriormorselized
bonegraftinginvertebraeforspinalfusionduringsurgery.GroupBpatients(n=50)werenottreatedwithmorselizedbonegrafting.
Kyphoticdeformity,anteriorvertebralheight,instrumentfailurerates,andneurologicalfunctionoutcomeswerecomparedbetweenthe
twogroups.ResultsKyphosiscorrectionwasachievedingroupA(morselizedbonegrafting)andgroupB.Attheendofthefollow-
upperiod,kyphosiscorrectionwasmaintainedingroupAbutlostingroupB(P=010001).Aftersurgery,greateranteriorvertebral
heightwasachievedingroupAthaningroupB(P<01001).Duringfollow-up,anteriorvertebralheightwasmaintainedonlyin
groupA(P<01001).PatientsinbothgroupsAandBdemonstratedgoodpostoperativeDenispainscalegrades,butgroupAhadbetter
resultsthangroupBintermsofthecontrolofsevereandconstantpain(P4andP5)(P<01001).ThefrankelperformanceScalescores
ingroupAwasbetterthangroup