经伤椎椎弓根植骨联合伤椎椎弓根螺钉固定治疗胸腰段骨折
李 佳, 欧云生, 权正学, 蒋电明, 唐 可, 安 洪
中国临床解剖学杂志 ›› 2011, Vol. 29 ›› Issue (3) : 356-360.
经伤椎椎弓根植骨联合伤椎椎弓根螺钉固定治疗胸腰段骨折
Transpedicular intracorporeal grafting combined with posterior short-segment pedicle screw via the injured vertebra for treatment of thoracolumbar fractures
目的 探讨经伤椎椎弓根植骨联合伤椎椎弓根螺钉固定治疗胸腰椎骨折的临床疗效。 方法 回顾性研究2006年6月-2009年8月的52例胸腰段段骨折患者,均为AO分型中的A型骨折,采用经伤椎椎弓根植骨联合伤椎椎弓根螺钉固定治疗。患者手术前后和随访均行X线检查,测量伤椎椎体前缘高度值、Cobb's角。手术前后CT测量椎管内占位比并评估植骨情况。观察术后并发症和神经功能恢复情况。 结果 患者随访(16.5±7.8)月(12~30月)。无切口感染、神经症状加重,无内固定松动及断裂。伤椎前缘高度术后和末次随访均较术前恢复满意。Cobb's角术后和末次随访无明显矫正丢失。椎管内占位比为较术前明显改善。神经功能较术前均有1~2级的改善。 结论 伤椎椎弓根植骨可有效修复伤椎复位后的椎体缺损,伤椎椎弓根螺钉固定能有效重建骨折稳定性,前中后三柱重建稳定,是治疗胸腰椎A型骨折的一种有效方法。
Objective To explore the clinical efficacy of transpedicular intracorporeal grafting combined with posterior short-segment pedicle screw via the injured vertebra for thoracolumbar fractures treatment. Methods A total of 52 patients of thoracolumbar fractures were treated with transpedicular intracorporeal grafting combined with posterior short-segment pedicle screw via the injured vertebra from June 2006 to December 2009. According to the AO classification, all of them are type A fracture. Preoperative, postoperative and follow-up X-ray were performed for evaluating anterior heights of the injured vertebra(AHIV) and Cobb's angle, as well, preoperative and postoperative CT scans were taken to measure the sagittal canal diameter(SCD). Postoperative complications and neurofunctional recovery of the spinal cord were evaluated. Results All cases were followed up about 12 to 30 months, averagely 16.5±7.8 months. There was no infection of incision and no aggravation of spinal cord function. There was no implant failure and no loss of spinal curvatures. After surgery and at final follow-up, anterior heights of the injured vertebra showed good recovery, and Cobb's angel appeared smaller. The sagittal canal diameter significantly reduced compared to that before surgery. In patients with incomplete injury, neurofunctions showed 1 to 2 grade improvement compared with the findings before operation. Conclusions Transpedicular intracorporeal grafting is effective to repair fractured vertebrae in the vertebral body defects, posterior short-segment pedicle screw via the injured vertebra can reconstruct the stability of thoracolumbar fractures, stable reconstruction of the anterior and middle columns and secured fixation of the posterior column. This technique is an effective method for treatment of A type thoracolumbar fractures.
Thoracolumbar fractures / Pedicle screw / internal fixation / Injured vertebra / Bone grafting
[1] Butt MF, Farooq M, Mir B, et al. Management of unstable thoracolumbar spinal injuries by posterior short segment spinal fixation
[J]. Int Orthop, 2007, 31(2):259-264.
[2] Dai LY, Jiang SD, Wang XY, et al. A review of the management of thoracolumbar burst fractures
[J]. Surg Neurol, 2007, 67:221-231.
[3] Alvine GF, Swain JM, Asher MA, et al. Treatment of thoracolumbar burst fractures with variable screw placement or Isola instrumentation and arthrodesis: case series and literature review
[J]. J Spinal Disord Tech, 2004,17(4):251–264.
[4] 吕失新,黄勇,张强,等.胸腰椎骨折伤椎椎弓根内固定生物力学研究与临床应用
[J].脊柱外科杂志,2008,6(4):229 -233.
[5] Mahar A,Kim C,Wedemeyer M,et a1.Short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture
[J].Spine,2007,32(14):1503-1507.
[6] Anekstein Y, Brosh T, Mirovsky Y. Intermediate screws in short segment pedicular fixtion for thoracic and lumbar fractures:a biomechanical study
[J]. J Spinal Disord Tech, 2007,20(1):72-77.
[7] 杜心如,赵玲秀,石继川,等.经伤椎椎弓根螺钉复位治疗胸腰椎爆裂骨折的临床解剖学研究
[J].中国临床解剖学杂志,2007,25(3):239-242.
[8] Kopperdahl DL, Morgan EF, Keaveny TM. Quantitative computed tomography estimates of the mechanical properties of human vertebral trabecular bone
[J].J Orthop Res, 2002, 20(4):801-805.
[9] 刘团江,郝定均,王晓东, 等. 胸腰段骨折椎弓根钉复位固定术后骨缺损的CT研究
[J]. 中国矫形外科杂志,2003,11(10):706-707.
[10] 叶启彬,邱贵兴.脊柱外科新手术
[M].第2版.北京:中国协和医科大学出版社,2001:79.
[11]Toyone T, Tanaka T, Kato D, et a1. The treatment of acute thoracolumbar burst fractures with transpedicular intracorporeal hydroxyapatite grafting following indirect reduction and pedicle screw fixation: A prospective study
[J]. Spine, 2006, 31(7):E208-214.
[12.]Sepulveda P, Bressiani AH, Bressiani JC, et al. In vivo evaluation of hydroxyapatite foams
[J]. J Biomed Mater Res, 2002, 62(4): 587-929.
[13]欧云生, 蒋电明, 权正学, 等. 纳米羟基磷灰石/聚酰胺66复合生物活性人工椎体在胸腰椎骨折前路重建手术中的应用
[J]. 中国修复重建外科杂志, 2007, 21(10): 1084-1089.
[14]欧云生, 蒋电明, 权正学, 等. 复合生物活性融合器在颈椎病前路减压融合术中的初步应用研究
[J]. 生物医学工程学杂志, 2010, 27(2): 324-327.
国家高科技研究发展计划(863)资助项目(2002AA32 6020);重庆市卫生局医学科技计划项目(06-2-020)
/
〈 |
|
〉 |