伤椎置钉并椎体内植骨治疗胸腰椎骨折的疗效观察

孟晋，彭谊

（陕西省镇安县医院骨科，陕西 商洛，711500）

浏览次数：89次 下载次数：298次

摘要：

目的 观察胸腰椎爆裂性骨折经后路椎弓根螺钉内固定并伤椎植骨结合伤椎置钉的远期疗效。方法 对我院收治的36 例胸腰椎爆裂性骨折患者行后路椎弓根螺钉内固定术并伤椎植骨结合伤椎置钉，观察随访结果。结果 所有患者恢复良好， 伤椎骨性愈合，脊柱序列可，伤椎高度恢复良好，内固定无松动、无断钉及断棒现象。内固定取出后伤椎高度无丢失，无脊椎 后凸畸形。患者术后Cobb 角、伤椎前后缘高度比、椎体楔变角优于术前（P<0.05），术后各时间点差异不显著（P>0.05）。结论 后路椎弓根螺钉内固定并伤椎植骨结合伤椎置钉符合脊柱的生物力学结构，可有效防止内固定失效，伤椎愈合良好。

关键词：伤椎植骨；胸腰椎骨折；伤椎置钉

中图分类号：R687.3文献标志码：A文章编号：2096-1413(2017)35-0062-02

Curative effect observation of screwing on the injured vertebra and bone grafting in vertebral body in the treatment of thoracolumbar spine fracture
MENG Jin, PENG Yi
(Orthopedics Department, the Hospital of Zhen``an County, Shangluo 711500, China)

ABSTRACT: Objective To observe the long-term effect of posterior pedicle screw fixation and vertebral interbody fusion with vertebral pedicle screws. Methods Thirty-six patients with thoracolumbar burst fractures in our hospital were treated with posterior pedicle screw fixation and vertebrae interbody fusion with vertebral predicle screws, the follow-up results were observed. Results All patients recovered well, the vertebral bone showed healing, spine sequence and vertebral height recovered well, there was no loose internal fixation, no broken nail and broken bar. Vertebral height didn``t lose after removal of internal fixation, without kyphosis. The postoperative Cobb angle, anteroposterior and posterior margin height ratio and vertebral wedge angle were significantly better than those before operation (P<0.05), but those at different postoperative time had no significant difference (P>0.05). Conclusion Posterior pedicle screw fixation and vertebral bone graft combined with injury vertebral pedicle screw is consistent with the biomechanics structure of spine, which can effectively prevent the failure of internal fixation and the injured vertebral column heals well.
KEYWORDS: injury vertebral bone graft; thoracolumbar spine fracture; injury vertebral pedicle screw

参考文献：
[1] WEINSTEIN JN,PRATT KF,SPENGLER D,et al.Spinal pedicle fixation:reliability and validity of roentgenogram-based assessment and surgical factors on successful screw placement[J].Spine,1988,13(9):10-12.
[2] 曹治东,李邦春,苟景跃,等.经椎弓根植骨在伴有骨质疏松的胸腰 椎骨折中的应用[J].中国矫形外科杂志,2007,15(6):421-423.
[3] PARK JW,LANE JR,KARAIKOVIC EE,et al.Successful short -segment instrumentation and fusion for thoracolumbar spinefracyure:aconsecutive4.5-yearseries[J].Spine,2000,25(9):1157-1170.
[4] 何立文,王荣生,石裕明,等.椎弓根内固定联合伤椎植骨治疗胸腰 椎骨折[J].中国医学创新,2016,13(22):44-47.
[5] ALANAY A,ACAROGLU E,YAZICI M,et al.The effect of transpedicular intracorporeal grafting in the treatment of thor aclumbar burst fractures on canal remodeling[J].Eur Spine J,2001,10(6):512-516.
[6] 叶春万,朱敏,甘业春,等.计算骨丧失量经椎弓根打压植骨治疗胸腰椎压缩性骨折的生物力学研究与临床应用[J].中国骨与关节损伤 杂志,2011,26(5):394-397.
[7] 李利,史亚民,侯树勋,等.后路手术治疗胸腰椎骨折[J].脊柱外科杂志,2003,1(2):81-83.
[8] 昌耘冰,范志丹,夏虹,等.应用伤椎置钉技术治疗胸腰椎骨折的生物力学研究与临床应用[J].中国临床解剖学杂志,2009,27(3):347-350.
[9] 熊剑,宋志会.伤椎置钉与不置钉短节段内固定治疗胸腰椎爆裂性 骨折的比较[J],实用骨科杂志,2016,22(6):46-49.