改良漏斗椎弓根植骨治疗胸腰椎骨折疗效分析

目的:分析改良漏斗经椎弓根伤椎内植骨治疗胸腰椎骨折的临床疗效。方法:自2006年5月至2011年11月,采用后路椎弓根螺钉固定、复位并联合改良椎弓根漏斗伤椎内植入自体髂骨治疗胸腰椎骨折患者35例(严重压缩性骨折9例、爆裂性骨折26例),男19例,女16例;年龄21～66岁,平均34.6岁。术后通过X线片动态测量伤椎前缘高度及Cobb角;CT评估植骨效果并最终测定植骨区CT值;神经功能采用Frankel分级评定;疼痛按照视觉模拟评分。结果:32例均获得随访,时间18～37个月,平均19.7个月。无神经损伤加重,术前11例神经功能部分损害者有至少1级的恢复;无内固定松动或断裂,伤椎内植骨填充良好,6个月内全部融合,植骨区无贯通式腔隙。伤椎前缘高度比由术前(50.17±8.26)%恢复至术后(90.79±4.85)%,末次随访时(内固定取除后6个月)为(90.34±4.03)%;Cobb角由术前(28.70±6.24)°恢复到术后(7.26±3.79)°,末次随访时为(7.34±4.05)°。末次随访伤椎植骨区平均CT值均明显高于邻椎;疼痛视觉模拟评分平均为1.06分。结论:后路椎弓根固定、复位并联合改良漏斗伤椎内植骨治疗胸腰椎爆裂性骨折简便、安全且经济,伤椎空腔内植骨效果良好,可有效防止伤椎高度再丢失和进行性后凸畸形,最大程度地保留脊柱运动功能。

Modified funnel method transpedicular bone graft in the treatment of thoracolumbar vertebral fractures

Objective:To explore efficacy of modified funnel method for transpedicular bone grafting in treating thoracolumbar vertebras fracture. Methods:From May 2006 to November 2011,35 patients(19 males and 16 females,ranged in age from 21 to 66 years with an average of 34.6 years) with thoracolumbar vertebras fracture were treated by posterior pedicle screw fixation,reduction and modified funnel method for transpedicular autogenous iliac bone grafting. Of the 35 cases,9 cases were severe compression fracture and 26 cases were burst fracture. The anterior body height and Cobb' s angle of injured vertebral were measured by X-ray; the effect of implantation bone and CT value were assessed by radiograph CT scan; Nerve function were evaluated according to Frankel' s neurological function classification and back pain were evaluated by visual analogue scale(VAS). Results:Thirty-two patients were followed up from 18 to 37 months with an average of 19.7 months. No nerve injuries aggravated,and 11 patients with partial nerve injuires preoperatively were improved at least 1 level recovery postoperatively; Breakage or loosen of screws were not found. Vertebral bone grafting filled well,bone fusion were got after 6 months' treatment and without cavity gap in grafting bone area. The anterior vertebral height was improved respectively from preoperative (50.17±8.26)% to postoperative(90.79±4.85)%,and (90.34±4.03)% at the final follow-up. The Cobb's angle improved from preoperative (28.7±6.24)° to postoperative (7.26±3.79)°,with (7.34±4.05)°at the final follow-up. CT value of injured vertebras at the final follow-up were significantly higher than adjacent vertebras'. The average VAS was 1.06. Conclusion:Posterior pedicle screw fixation,reduction and modified funnel method for transpedicular autogenous iliac bone grafting is a feasible and safe method for the treatment of thoracolumbar vertebras fracture. It can effectively prevent bone loss of injured vertebral height,progressive deformity of kyphosis,and keep spinal movement function at the maximum.