摘要
背景:胸腰椎爆裂性骨折合并脊髓神经损伤在后路椎弓根螺钉内固定同时需进行椎管减压,脊柱后侧结构受到破坏,目前后外侧植骨融合所有固定节段仍然是主要的修复方法。为了进一步减少融合节段,保留运动单元,有必要在内固定及减压同时进行脊柱选择性融合。目的:通过与后外侧全部固定节段植骨融合相比,探讨后外侧选择性损伤节段融合修复胸腰椎骨折合并脊髓神经损伤的优势。方法:对2006年1月至2013年7月采用后路短节段经伤椎单侧椎弓根置钉椎管减压、后外侧植骨融合修复胸腰椎爆裂骨折的83例患者资料进行回顾性分析,根据融合节段分组,选择性植骨融合组42例行后外侧选择性损伤节段植骨融合,全部植骨融合组41例行后外侧全部固定节段植骨融合。对两组患者的围手术期指标、内固定情况、伤椎椎体前缘高度丢失率、Cobb角、脊髓神经恢复及Oswestry功能障碍指数进行比较。结果与结论:1所有患者均获得25-32个月随访。2两组患者手术时间、术中出血量及下地活动时间差异无显著性意义(P>0.05);选择性植骨融合组术后引流量小于全部植骨融合组(P<0.05)。两组患者取出内固定前无内固定松动及钉、棒断裂。3两组治疗后各时间点的伤椎椎体前缘高度丢失率、Cobb角与治疗前比较均明显改善(P<0.05),两组间治疗后各时间点的伤椎椎体前缘高度丢失率、Cobb角差异无显著性意义(P>0.05)。4两组间比较治疗后6个月完全融合率差异无显著性意义(P>0.05);两组部分融合病例在内固定取出前全部融合。5两组治疗后脊髓神经功能均有一定程度恢复,末次随访Oswestry功能障碍指数两组间差异无显著性意义(P>0.05)。6结果表明与后外侧全部固定节段植骨融合相比,后外侧选择性损伤节段植骨融合同样可以维持椎体高度及预防Cobb角再丢失,减少内固定松动、断裂。同时选择性损伤节段植骨融合在内固定取出后可减少脊柱运动单元丧失,从而降低邻近节段间盘退变发生。
BACKGROUND：Spinal canal decompression is needed in posterior pedicle screw fixation surgery for thoracolumbar burst fractures combine with spinal cord injury.The structure of posterior spine is often damaged.The posterolateral bone fusion in all fixed segment is still the main surgery.In order to further reduce fusion segment and maintain motor unit,it is necessary to perform selective segmental bone graft fusion during fixation and decompression.OBJECTIVE：To discuss the advantages of selective posterolateral vertebral fusion for thoracolumbar fracture with spinal injury through comparing with posterolateral vertebral fusion.METHODS：Data of 83 thoracolumbar burst fracture cases,who received posterior lumbar decompression and short segment fixation with pedicle screws and bone graft through injured vertebra from January 2006 to July 2013,were analyzed retrospectively.According to fusion segments,above patients were divided into selective posterolateral vertebral fusion group（n=42） and the whole posterolateral vertebral fusion group（n=41）.Perioperative index,internal fixation,vertebral height loss rate,Cobb angle,spinal nerve recovery and Oswestry Disability Index were compared between the two groups.RESULTS AND CONCLUSION：（1） All cases were followed up for 25-32 months.（2） There was no statistical significance in operation time,intraoperative blood loss and ambulation time between the two groups（P〉0.05）.Postoperative drainage volume was less in the selective posterolateral vertebral fusion group than in the whole posterolateral vertebral fusion group（P〈0.05）.Before removal of fixator,there was no loosened fixator or breakage of screw or stick.（3） There were improvements in the rate of vertebral front height loss and Cobb angle in both groups at various time points after operation（P〈0.05）.There was no statistical significance in the rate of vertebral front height loss and Cobb angle in both groups（P〉0.05）.（4） There was no significant difference in fusion rate at 6 months after treatment between the two groups（P〉0.05）.Fusion was achieved in both groups before removal of the fixator.（5） Spinal nerve recovery was found after treatment in both groups.No significant difference in Oswestry Disability Index was detected in final follow-up（P〉0.05）.（6） Results verified that compared with the whole posterolateral vertebral fusion,selective posterolateral vertebral fusion can obtain a good vertebral height and prevent Cobb angle loss again,reduce the internal fixation loosening and breakage.After removal of the fixator,selective posterolateral vertebral fusion can reduce spinal motion unit lost,and decrease the adjacent vertebral degeneration.
出处
《中国组织工程研究》
CAS
北大核心
2016年第17期2488-2495,共8页
Chinese Journal of Tissue Engineering Research
