椎弓根螺钉内固定术联合经伤椎椎弓根植骨治疗胸腰椎骨折对患者椎体高度恢复的影响

目的 探讨经后路椎弓根钉内固定联合经伤椎椎弓根植骨治疗胸腰椎骨折的临床疗效.方法 筛选第三军医大学西南医院骨科和重庆市渝北区人民医院骨科2010年1月至2016年12月收治的426例胸腰椎骨折患者,按照不同手术方式分为:观察组(n=118),采用经伤椎椎弓根进行椎体植同种异体骨+后路GSS-Ⅳ型脊柱通用内固定系统固定;对照组(n=308),单纯使用后路GSS-Ⅳ型脊柱通用内固定系统进行治疗.回顾性分析两组患者手术前后功能疼痛视觉模拟评分(VAS评分)、伤椎前缘高度比值、Cobb角改变及其并发症发生率.结果 ①两组手术前后伤椎前缘高度比值、Cobb角改变、VAS评分等比较,差异均具有统计学意义(P＜0.05).②与对照组相比,观察组手术时间差异有统计学意义(P＜0.05);术中出血量较对照组较多,但差异无统计学意义(P＞0.05);术后1个月及1年伤椎前缘高度比值、Cobb角改变差异具有统计学意义(P＜0.05);术后1个月VAS评分差异无统计学意义(P＞0.05);术后1年VAS评分较低,但差异无统计学意义(P＞0.05).结论 经伤椎椎弓根进行植骨可以达到更满意的临床效果,适合临床推广使用.

Effect of pedicle screw fixation combined with transpedicular intracorporeal grafting on restoration of vertebral height in patients with thoracolumbar fractures

Objective To investigate the clinical efficacy of posterior pedicle screw internal fixation and transpedicular intracorporeal bone grafting in the treatment of thoracolumbar fractures.Methods A total of 426 patients with thoracic and lumbar fractures admitted in People's Hospital of Yubei District and Southwest Hospital from January 2010 to December 2016 were recruited in this study.They were divided into the observation group (n =118,transpedicular intracorporeal bone allografting with posterior GSS-Ⅳ internal fixation) and control group (n =308,only posterior GSS-Ⅳ internal fixation).Score of visual analogue scale (VAS),ratio of anterior vertebral height,change of Cobb angle,and the incidence rate of complications were compared before and after the treatment,and between the 2 groups.Results ① Significant differences were seen in the ratio of anterior vertebral height,change of Cobb angle and VAS score before and after the treatment in both groups (P ＜ 0.05).② Compared with the control group,the observation group had significantly shorter operation time (P ＜ 0.05),better results in anterior vertebral height ratio and Cobb angle changes (P ＜ 0.05),larger intra-operative blood loss but without statistical difference (P ＞ 0.05),no difference in VAS score in 1 month after operation (P ＞ 0.05),and lower VAS score in 1 year after operation though still no notable difference (P ＞ 0.05).Conclusion Transpedicular bone grafting obtains sound outcomes in treatment of thoracolumbar fractures,and is worthy of promotion in clinical practice.