椎体内植骨结合椎弓根钉棒系统治疗胸腰椎骨折的疗效分析

目的：分析采用人工骨经椎弓根椎体内植骨结合脊柱钉棒系统治疗胸腰椎骨折的疗效。方法：将60例胸腰椎骨折患者分为两组,研究组30例,采用人工骨经椎弓根椎体内植骨联合脊柱钉棒系统内固定;对照组30例,采用单纯脊柱钉棒系统内固定。比较两组的后凸畸形角度及矫正角度,手术前、后的椎体前缘高度以及内固定取出后3个月时的椎体前缘高度,采用Frankel功能分级和Denis疼痛分级方法评价神经功能的改变。结果：研究组和对照组手术前的后凸畸形Cobb’s角分别为（19.3±11.3）°、（18.3±9.1）°,差异无统计学意义;术后两组后凸畸形矫正度数分别为（5.4±0.8）°、（5.1±0.9）°,较术前差异有统计学意义。研究组和对照组手术前损伤椎体的前缘高度分别为（53.1±11.9）%、（54.0±8.9）%,差异无统计学意义;手术后的前缘高度分别为（86.2±9.9%）、（71.3±6.30%）,两组比较差异有统计学意义（P〈0.01）。内固定取出后3个月随访发现,研究组矫正度数丢失（0.30±1.41）°,对照组矫正度数丢失（6.20±6.70）°,差异有统计学意义（P〈0.01）。研究组的椎体前缘高度丢失（0.15±5.06）%,基本无丢失;对照组椎体前缘高度丢失（-5.18±2.21）%,有明显变化（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,术后神经功能分级研究组平均提高了（1.1±0.3）级,对照组平均提高了（0.6±0.2）级。结论：采用人工骨经椎弓根椎体内植骨联合脊柱钉棒系统治疗胸腰椎骨折,能有效恢复椎体高度和防止术后矫正度的丢失。

Transpedicular Screw Fixation Combined with Bone Grafting in the Fractured Vertebral Body for the Treatment of Thoracolumbar Vertebral Fractures

Objective：To assess the curative effect of transpedicular screw fixation combined with bone grafting in the fractured vertebral body through pedicle passage in the treatment of thoracolumbar vertebral fractures.Methods：A total of 60 patients were enrolled and divided into two groups randomly.Patients in the study group（n=30）were treated with posterior transpedicular screw fixation combined with bone grafting in the fractured vertebral body;patients in the control group（n=30）were treated with posterior transpedicular screw fixation only.All the patients were followed up clinically and radiologically by X-ray and computed tomography after the operation as well as after removal of internal fixation.The anterior vertebral height between injured level and upper level,and vertebral wedge angles were calculated.Neurologic functions were recorded and analyzed with Frankel scale and Denis pain scale.Results：Vertebral wedge angle and anterior vertebral height at the injured level were greatly higher in study group after operation（P0.001）.No neurological deterioration was observed.Scores of Frankel scale and Denis scale were significantly higher in study group,and in26 cases a one grade or better improvement was observed.Conclusions：Posterior transpedicular screw fixation combined with bone grafting in the fractured vertebral body for thoracolumbar vertebral fractures can achieve favorable effect.