经椎弓根椎体内植骨治疗胸腰椎骨折的影像学观察

【摘要】目的通过38例病例观察椎体内植骨的转归以及椎体内植骨术对胸腰椎骨折复位术后防止矫正度丢失的作用。方法通过术前、术后即刻、术后12个月随访时的侧位x线片，测量伤椎前缘高度比和后缘高度比的变化，分析椎体内植骨在伤椎形态恢复、防止矫正度丢失中的作用；通过术前、术后和随访时的螺旋cT资料，应用PhotoshopCS8．0软件中的“磁性套索”工具对不同时期的植入骨块相对面积和骨缺损相对面积进行测量、比较，观察植入骨块和骨缺损的转归。结果术后12个月时，椎体前、后缘高度比分别降低了0．28％（P=0．071）和0．17％（P=0．086），差异无统计学意义；植入骨块相对面积逐渐缩小，由34．12％降低到13．56％，无新生空腔；骨缺损相对面积逐渐缩小，由18．53％降低到9．29％。结论经椎弓根椎体内植骨可以切实有效地消除伤椎内的空隙，恢复伤椎的结构完整性和初始稳定性；植入的骨粒通过诱导骨愈合，能够维持伤椎的结构完整性和力学稳定性；椎体内的空隙不能完全自愈。

Imaging observation of transpedicular intracorporeal grafting in the treatment of thoracolumbar fractures

Objective To observe the prognosis of intracorporeal grafting and its effects in preventing the loss of correction after the reduction ofthoracolumbar fractures in 38 cases. Methods The ratios of anterior height and posterior height of the injured vertebral body were measured based on the lateral X-ray films preoperatively, immediate after the surgery and at the 12th month after the operation. The effects of intracorporeal grafting were analyzed in promoting the recovery of the morphology of the injured vertebral body and preventing the loss of correction. Based on the spiral computed tomography （ CT ） results preoperatively, postoperatively and in the follow-up, the relative areas of the grafted bone blocks and the bone defects were measured and compared at different times with the Magnetic Lasso tool in the software of Photoshop CS 8.0, and the prognoses of the grafted bone blocks and the bone defects were observed. Results At the 12th month after the operation, the ratios of anterior height and posterior height of the injured vertebral body were decreased by 0.28% （ P=0.071 ） and 0.17% （ P=-0.086 ） respectively, and no statistical differences were found. The relative area of the grafted bone blocks was reduced gradually from 34.12% to 13.56%, without new cavities. The relative area of the bone defects was reduced gradually from 18.53% to 9.29%. Conclusions Transpedicular intracorporeal grafting can effectively eliminate the space and restore the structural integrity and initial stability of the injured vertebral body. The bone healing which is grafted in the vertebral body can maintain the structural integrity and mechanical stability of the injured vertebral body. The bone cavities cannot completely heal naturally.