后外侧植骨与经椎弓根植骨治疗胸腰段脊柱爆裂骨折的疗效比较

目的 比较胸腰段脊柱爆裂骨折短节段内固定结合后外侧植骨(posterohteral fusion,PLF)与经椎弓根植骨(transpedieular grafting,TPG)的疗效.方法 手术治疗胸腰段脊柱爆裂骨折患者62例,根据手术方式不同,分为PLF组和TPG组.PLF组行短节段内固定加自体髂骨PLF,34例;TPG组行短节段内固定加经椎弓根椎体内植骨,28例.记录手术时间、失血量、住院时间,在术前、术后及末次随访X线片上测量Cobb角、伤椎相对高度,末次随访的过伸过屈位X线片上测量手术节段运动范围,功能评定采用Greenough腰痛评分法(LBOS).平均随访时间:PLF组29个月,TPG组24个月.结果 PLF组平均住院时间20.1 d,术前平均Cobb角20.8°,椎体相对高度降低48.5%,术后平均Cobb角3.1°,椎体相对高度降低6.7%,末次随访平均Cobb角矫正丢失3.7°,椎体相对高度矫正丢失4.0%;TPG组平均住院时间18.8 d.术前平均Cobb角19.0°,椎体相对高度降低46.7%,术后平均Cobb角2.5°,椎体相对高度降低5.%,末次随访平均Cobb角矫正丢失3.9°,椎体相对高度矫正丢失3.5%,两组比较差异无统计学意义.TPG组平均手术时间182.0 min,平均失血量423 ml,供骨区并发症发生率3.6%,低于PLF组的233.0 min、614 ml与23.5%;TPG组手术节段运动范围7.4°,优于PLF组的0.8°.两组术后各时间段LBOS评分差异无统计学意义.结论 胸腰段脊柱短节段固定结合两种植骨方式的短期结果均满意.TPG手术具有如下优点:缩短手术时间、失血量少、减少供骨区并发症,保留手术节段运动范围.

Comparative study of posterolateral fusion versus transpedicular grafting for surgically treated burst fractures of thoracolumbar spine

Objective To compare the results of posterolateral fusion(PLF)versus transpedicular grafting(TPG)for surgically treated burst fractures of the thoracolumbar spine.Methods Sixty-two patients were included in this study.All patients were randomly assigned to PLF group(n=34)or TPG group (n=28),and operative treatment with posterior reduction and instrumentation was carried out.The operative time.estimated blood loss.1ength of hospital stay.low back outcome scores and the radiographic parameters were recorded and were finally statistical analysed.The average follow-up period was 29 months for PLF group,and 24 months for TPG group.Results The total hospital stay(20.1 d vs 18.8 d),mean preoperative kyphotic angle(20.8°vs 19.0°),mean postoperative kyphotic angle(3.1°vs 2.5°),mean loss of kyphotic angle(3.7°vs 3.9°),the decreased preoperative vertebral body height(VBH,48,5% vs 46.7%),decreased postoperative VBH(6.7% vs 5.9%),lost correction of decreased VBH(4.0% vs 3.5%)were not statistically significant between these two groups.The angular change in the flexion-extension lateral view(0.8°vs 7.4°),operative estimated blood 1088(614 ml vs 423 ml),and operative time(233.0 min vs 182.0 min)were statistically significantly better in the TPG group.The scores on the low back outcome scale were not statistically significant for these two groups.Conclusion The short-term results of short segmental fixation with PLF and TPG for surgically treated burst fractures of the thoracolumbar spine were satisfactory.The advantages of instrumentation with TPG are the elimination of donor site complications,saving more motion segments,and reducing blood loss and operative time.