经椎弓根椎间植骨并椎弓根螺钉固定损伤椎体治疗胸腰椎骨折

[Treatment of thoracolumbar fractures with transpedicular intervertebral bone graft and pedicle screws fixation in injured vertebrae].

作者信息

Li Qinliang, Liu Yi, Chu Zhaoming, Chen Jinchuan, Chen Ming

机构信息

Department of Orthopaedics, Affiliated Lianyungang Hospital of Xuzhou Medical College, Lianyungang Jiangsu 222000, PR China.

出版信息

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011 Aug;25(8):956-9.

PMID:21923024

Abstract

OBJECTIVE

To study the effectiveness of transpedicular intervertebral bone graft and pedicle screws fixation in injured vertebrae for the treatment of thoracolumbar fractures.

METHODS

Between February 2007 and January 2009, 25 patients with thoracolumbar fractures were treated by posterior short-segment fixation combined with transpedicular intervertebral bone graft and pedicle screw fixation in injured vertebrae. There were 18 males and 7 females with a mean age of 46 years (range, 28-63 years). The injured vertebrae were located at T10 in 1 case, T11 in 2 cases, T12 in 8 cases, L1 in 6 cases, L2 in 6 cases, L3 in 1 case, and L4 in 1 case. According to Denis classification, there were 14 cases of burst fractures and 11 cases of compression fractures. Based on Frankel classifications, 2 cases were rated as grade A, 4 cases as grade B, 8 cases as grade C, 7 cases as grade D, and 4 cases as grade E. The time between injury and operation was 6 hours to 7 days (mean, 4.6 days). The X-ray film was taken to measure the relative height of fractured vertebrae and Cobb angle, and Frankel classification was conducted to evaluate the function recovery of the spinal cord.

RESULTS

The operations were performed successfully, and incisions healed primarily. All the patients were followed up 12-25 months (mean, 16 months). CT and X-ray films showed good bone graft healing and no loosening or breakage of screws and rods. The relative height of fractured vertebrae were 56.8% +/- 15.6% at preoperation, 91.2% +/- 10.7% immediately after operation, and 89.6% +/- 10.3% at 1 year after operation, showing significant differences between preoperation and postoperation (P < 0.01), while no significant difference between immediately after operation and 1 year after operation. The Cobb angles were (18.2 +/- 2.6), (7.5 +/- 1.4), and (8.7 +/- 1.1) degrees, respectively, showing significant differences between preoperation and postoperation (P < 0.01), while no significant difference between immediately and 1 year after operation. At 1 year after operation, the neural function in 16 cases was improved 1-3 grades.

CONCLUSION

Treatment of thoracolumbar fractures with transpedicular intervertebral bone graft and pedicle screw fixation in injured vertebrae has satisfactory effectiveness, which can reconstruct vertebral body height, increase the stability of anterior and middle column of the injured vertebrae, and prevent height loss of the injured vertebrae and loosening of instrumentation.

摘要

目的

研究经椎弓根椎间植骨并椎弓根螺钉固定伤椎治疗胸腰椎骨折的疗效。

方法

2007年2月至2009年1月，对25例胸腰椎骨折患者采用后路短节段固定并经椎弓根椎间植骨及椎弓根螺钉固定伤椎治疗。其中男性18例，女性7例，平均年龄46岁（范围28 - 63岁）。伤椎位于T10 1例，T11 2例，T12 8例，L1 6例，L2 6例，L3 1例，L4 1例。按Denis分类，爆裂骨折14例，压缩骨折11例。按Frankel分级，A级2例，B级4例，C级8例，D级7例，E级4例。受伤至手术时间为6小时至7天（平均4.6天）。拍摄X线片测量骨折椎体相对高度及Cobb角，并进行Frankel分级以评估脊髓功能恢复情况。

结果

手术均成功完成，切口一期愈合。所有患者随访12 - 25个月（平均16个月）。CT及X线片显示植骨愈合良好，螺钉及棒无松动或断裂。骨折椎体相对高度术前为56.8%±15.6%，术后即刻为91.2%±10.7%，术后1年为89.6%±10.3%，术前与术后比较差异有统计学意义（P < 0.01），术后即刻与术后1年比较差异无统计学意义。Cobb角分别为（18.2±2.6）、（7.5±1.4）和（8.7±1.1）度，术前与术后比较差异有统计学意义（P < 0.01），术后即刻与术后1年比较差异无统计学意义。术后1年，16例患者神经功能改善1 - 3级。