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

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=0.0001)。术后伤椎前缘高度百分比增加值两组比较有显著差异(P<0.001)。术后随访中,A组伤椎椎体前缘高度无丢失(P<0.001),B组伤椎椎体前缘高度有丢失(P<0.05)。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。

Treatment of Thoracolumbar Vertebrae Fractures with Posterior Morselized Bone Grafting in Vertebrae for Spinal Fusion and Pedicle Screw Fixation

Objective To evaluate the efficacy of reinforcing short-segment pedicle screw fixation with posterior morselized bone grafting in vertebrae for spinal fusion in patients with thoracolumbar vertebrae fractures.Methods The70 patients with thoracolumbar vertebrae fractures underwent short-segment pedicle screw fixation.Fractures in group A(n =20) were reinforced with posterior morselized bone grafting in vertebrae for spinal fusion during surgery.Group B patients(n =50) were not treated with morselized bone grafting.Kyphotic deformity,anterior vertebral height,instrument failure rates,and neurological function outcomes were compared between the two groups.Results Kyphosis correction was achieved in group A(morselized bone grafting) and group B.At the end of the follow-up period,kyphosis correction was maintained in group A but lost in group B(P=0.0001).After surgery,greater anterior vertebral height was achieved in group A than in group B(P<0.001).During follow-up,anterior vertebral height was maintained only in group A(P<0.001).Patients in both groups A and B demonstrated good postoperative Denis pain scale grades,but group A had better results than group B in terms of the control of severe and constant pain(P4 and P5)(P<0.001).The frankel performance Scale scores in group A was better than group B(P<0.001).Conclusion Reinforcement of short-segment pedicle fixation with morselized bone grafting for the treatment of patients with thoracolumbar vertebrae fracture may achieve and maintain kyphosis correction,and it may also increase and maintain anterior vertebral height.Morselized bone grafting in vertebrae offers immediate spinal stability in patients with thoracolumbar vertebrae fractures,decreases the instrument failure rate,and provides better postoperative pain control than without morselized bone grafting.