硬脊膜外颗粒骨植骨融合的临床应用

目的：探讨脊柱后路减压后在硬脊膜外进行颗粒骨植骨融合的安全性。方法：2006年1月至2009年8月,对35例胸腰椎后路椎管减压患者在硬脊膜外及相邻椎板间颗粒骨植骨融合,男24例,女11例;年龄18～58岁,平均37岁。术后及不同随访时间行X线和CT检查,观察伤椎椎体高度恢复、神经功能恢复情况以及有无植骨所造成的医源性椎管狭窄。结果：所有患者获得随访,时间4～25个月,平均17个月。术后患者无内固定松动、断裂等并发症。CT提示无植骨造成的医源性椎管狭窄,伤椎椎体前缘高度由术前51%恢复至98%;Cobb角由术前平均25.2°恢复至术后1.6°,且内固定拆除后伤椎高度无丢失。按Frankel分级：35例胸腰椎爆裂骨折及骨折脱位患者神经功能提高1～3级。结论：脊柱后路减压患者采用硬脊膜外颗粒骨植骨融合重建了椎管,增加了脊柱稳定性,融合率高,而且不会造成医源性椎管狭窄,是一种简便、可靠、安全的手术方法。

Clinical evaluation of morselized bone graft fusion on epidural

Objective：To investigate the safety of epidural morselized bone graft fusion after posterior spinal decompression for the patients. Methods：From January 2006 to August 2009,41 patients who need posterior spinal decompression were treated with morselized bone graft fusion between adjacent vertebral lamina on epidural. There were 24 males and 11 females,ranging in age from 18 to 58 years with an average of 37 years. The height of injured spinal body,nerve functional recovery,iatrogenic spinal stenosis were observed or analyzed by X-rays and CT scannings before and after operation. Results：All the patients were followed up from 4 to 25 months with an average of 17 months. No internal fixation loosing or breakage or iatrogenic spinal stenosis caused by bone graft were found. The anterior height of compressed vertebral body restored from preoperative 51% to postoperative 98%. The Cobb angle was corrected from preoperative 25.2° to postoperative 1.6°. No loss of vertebral height after removal of internal fixation was found in all the patients. The nerve function of 35 patients with thoracolumbar bursting fractures and fractures and dislocations increased 1 to 3 grades according to Frankel standard. Conclusion：The technique of morselized bone graft fusion on epidural after posterior spinal decompression can rebuild and increase spinal stability,of which the rate of fusion is higher,moreover,it can not result in iatrogenic spinal stenosis. So it is an easy,reliable and safe operative method.