CAJ | 학술논문

目的：观察采用伤椎内植骨成形联合后路植骨椎弓根螺钉复位固定治疗重度胸腰椎爆裂性骨折的临床疗效。方法2007年10月至2013年5月该科采用经伤椎两侧椎弓根建立工作通道，把自体骨和同种异体骨粉碎成颗粒状植入伤椎椎体内，伤椎椎体成形。同时联合后外侧植骨，后路短节段钉棒系统复位固定治疗重度胸腰椎爆裂性骨折36例患者。伴有骨质疏松者予以骨水泥强化固定椎弓根螺钉。观察术前、术后、术后3、6个月、术后1年及最后1次随访时的临床表现及影像学资料。观察椎体内植骨及后路融合情况，测量椎管狭窄率、椎体后凸角（Cobb角）及伤椎前缘压缩率，评估腰痛程度和神经功能恢复情况。结果36例患者均获得随访，随访时间13个月至5年，平均3年2个月。术后椎管狭窄率[（3.4±1.2）％]、Cobb 角[（5.2±3.1）°]及伤椎前缘压缩率[（4.4±3.1）％]较术前[（67±10.6）％、（38±4.5）°、（43.2±21.7）％]均有显著改善，差异均有统计学意义（P<0.01），而与最后1次随访结果比较，差异均无统计学意义（P>0.05）。CT及X射线检查显示术后伤椎内植入骨充填良好，无伤椎“空壳”现象，复位的椎体高度无明显丢失，平均愈合时间3.5个月，后路植骨融合平均5.0个月，无假关节形成。无一例发生内固定失败。术前伴有神经损伤患者均有一定程度的改善。结论重度胸腰椎爆裂性骨折采用伤椎内植骨成形联合后路植骨椎弓根螺钉复位固定技术解决伤椎前、中柱骨缺损、骨量不足的问题，同时又增强了伤椎与临椎后柱的融合、固定。3柱的修复与稳定，有效地避免了远期内固定失败、伤椎高度再丢失带来的一系列并发症，临床疗效好，是一种可靠的治疗方法。
목적：관찰채용상추내식골성형연합후로식골추궁근라정복위고정치료중도흉요추폭렬성골절적림상료효。방법2007년10월지2013년5월해과채용경상추량측추궁근건립공작통도，파자체골화동충이체골분쇄성과립상식입상추추체내，상추추체성형。동시연합후외측식골，후로단절단정봉계통복위고정치료중도흉요추폭렬성골절36례환자。반유골질소송자여이골수니강화고정추궁근라정。관찰술전、술후、술후3、6개월、술후1년급최후1차수방시적림상표현급영상학자료。관찰추체내식골급후로융합정황，측량추관협착솔、추체후철각（Cobb각）급상추전연압축솔，평고요통정도화신경공능회복정황。결과36례환자균획득수방，수방시간13개월지5년，평균3년2개월。술후추관협착솔[（3.4±1.2）％]、Cobb 각[（5.2±3.1）°]급상추전연압축솔[（4.4±3.1）％]교술전[（67±10.6）％、（38±4.5）°、（43.2±21.7）％]균유현저개선，차이균유통계학의의（P<0.01），이여최후1차수방결과비교，차이균무통계학의의（P>0.05）。CT급X사선검사현시술후상추내식입골충전량호，무상추“공각”현상，복위적추체고도무명현주실，평균유합시간3.5개월，후로식골융합평균5.0개월，무가관절형성。무일례발생내고정실패。술전반유신경손상환자균유일정정도적개선。결론중도흉요추폭렬성골절채용상추내식골성형연합후로식골추궁근라정복위고정기술해결상추전、중주골결손、골량불족적문제，동시우증강료상추여림추후주적융합、고정。3주적수복여은정，유효지피면료원기내고정실패、상추고도재주실대래적일계렬병발증，림상료효호，시일충가고적치료방법。
Objective To evaluate the clinical effect of serious thoracolumbar vertebral burst fractures treated by transpedicular bone graft and posterior fixation with pedicle screws system and posterolateral bone graft. Methods A total of 36 patients with serious thoracolumbar burst fractures from Oct 2007 to May 2013 were treated by transpedicular bone graft with au_tologous and allogeneic bone chips combined with posterior fixation with pedicle screws system and posterolateral bone graft. For osteoporosis patients,bone cement was applied to reinforce screw fixation. The clinical outcome and imaging examination results before surgery,at the 3rd,6th,12th month after surgery and at the last follow up were studied. The condition of the bone graft and posterior cervical fusion was evaluated. The canalis vertebralis stenosis ,the Cobb′s angle and vertebral compression ratio were measured. The lumbago degree and neural functional recovery were assessed. Results All the patients were followed up to 3 years and 2 months in average(ranged from 13 months to 5 years). The canalis vertebralis stenosis,the Cobb′s angle and vertebral compression ratio[(3.4±1.2)%,(5.2±3.1)°,(4.4±3.1)%] were all significantly improved immediately after surgery with statistically significant difference(P<0.01),and there was no significant difference considering these parameters between immediately after surgery and at the last follow up(P>0.05). CT and X ray results showed the stable bone graft,no"shell"phenomenon,no vertebral body height lost,and an average healing time of 3.5 months. The average healing time for posterior cervical fusion was 5.0 months , and pseudarthrosis formation was not observed. Fixation failure did not occur in any of the studied cases. Nerve injuries were all improved to a certain degree after surgery. Conclusion Transpedicular bone graft combined with posterior fixation with pedicle screws system and posterolateral bone graft can solve the problem of bone defect of anterior and middle column in serious thora_columbar burst fractures,and in addition,it can reinforce the fusion and fixation between the fracture vertebra and the adjacent vertebra. The repaired and stable structure of three_column can effectively avoid the long term complications due to fixation failure and vertebral body height lost. The studied surgery procedure is reliable in the treatment of serious thoracolumbar burst fractures.