CAJ | 학술논문

背景：Denis B型胸腰椎爆裂骨折是常见的脊柱损伤，可能会累及上终板损伤。临床上常采用骨折复位椎弓根钉置入内固定对其进行修复，这种方案能够有效达到矫正后凸畸形的目的，但是遭受挤压破坏的骨小梁不能得到完全恢复。目的：观察骨折复位椎弓根钉置入内固定+伤椎椎体内人工骨植骨对Denis B型胸腰椎爆裂骨折的修复效果，并与单纯骨折复位椎弓根钉置入内固定进行对比。方法：回顾性分析2012年1月至2014年12月张家港澳洋医院骨科收治的70例Denis B型胸腰椎爆裂骨折患者的临床资料，根据修复方案分为两组，每组35例。对照组患者行骨折复位椎弓根钉置入内固定，观察组患者行骨折复位椎弓根钉置入内固定+伤椎椎体内人工骨植骨。对比观察两组患者在修复前、修复后1周、3个月、6个月的 Oswsetry功能障碍指数、伤椎前缘高度、腰背部疼痛目测类比评分以及伤椎后凸Cobb’s角。结果与结论：修复后1周、3个月、6个月，观察组患者的目测类比评分与对照组差异无显著性意义(P >0.05)；但观察组患者的ODI均显著低于对照组，差异有显著性意义(P<0.05)；观察组的伤椎体前缘高度与对照组差异无显著性意义(P>0.05)；但观察组患者的Cobb’s角均显著低于对照组，差异有显著性意义(P<0.05)。提示骨折复位椎弓根钉置入内固定+伤椎椎体内人工骨植骨对Denis B型胸腰椎爆裂骨折具有较好的修复效果，不仅能够有效矫正Cobb’s角和伤椎体前缘高度，还能通过对伤椎内进行骨填充，帮助脊柱正常载荷的恢复。
배경：Denis B형흉요추폭렬골절시상견적척주손상，가능회루급상종판손상。림상상상채용골절복위추궁근정치입내고정대기진행수복，저충방안능구유효체도교정후철기형적목적，단시조수제압파배적골소량불능득도완전회복。목적：관찰골절복위추궁근정치입내고정+상추추체내인공골식골대Denis B형흉요추폭렬골절적수복효과，병여단순골절복위추궁근정치입내고정진행대비。방법：회고성분석2012년1월지2014년12월장가항오양의원골과수치적70례Denis B형흉요추폭렬골절환자적림상자료，근거수복방안분위량조，매조35례。대조조환자행골절복위추궁근정치입내고정，관찰조환자행골절복위추궁근정치입내고정+상추추체내인공골식골。대비관찰량조환자재수복전、수복후1주、3개월、6개월적 Oswsetry공능장애지수、상추전연고도、요배부동통목측류비평분이급상추후철Cobb’s각。결과여결론：수복후1주、3개월、6개월，관찰조환자적목측류비평분여대조조차이무현저성의의(P >0.05)；단관찰조환자적ODI균현저저우대조조，차이유현저성의의(P<0.05)；관찰조적상추체전연고도여대조조차이무현저성의의(P>0.05)；단관찰조환자적Cobb’s각균현저저우대조조，차이유현저성의의(P<0.05)。제시골절복위추궁근정치입내고정+상추추체내인공골식골대Denis B형흉요추폭렬골절구유교호적수복효과，불부능구유효교정Cobb’s각화상추체전연고도，환능통과대상추내진행골전충，방조척주정상재하적회복。
BACKGROUND:Denis B thoracolumbar burst fractures are common spinal injury and may be involved in the upper end plate injury. Fracture reduction and pedicle screw fixation are used to repair above injury. This scheme can effectively achieve the aim of correcting deformity, but the trabecular bone after crushing cannot be fuly recovered. OBJECTIVE:To observe the repair effect of fracture reduction and pedicle screw fixation + artificial bone graft in vertebral body on Denis B thoracolumbar burst fracture, and compare with fracture reduction and pedicle screw fixation alone. METHODS:Clinical data of 70 cases of Denis B thoracolumbar burst fractures, who were treated in the Department of Orthopedics, Zhangjiagang Aoyang Hospital from January 2012 to December 2014, were retrospectively analyzed. According to repair scheme, they were equaly divided into two groups. Patients in the control group received fracture reduction and pedicle screw fixation. Patients in the observation group received fracture reduction and pedicle screw fixation + artificial bone graft in vertebral body. Oswsetry Disability Index, height of anterior border of injured vertebral body, lower back pain visual analogue scale and vertebral kyphosis Cobb’s angle were compared and observed between the two groups before repair, 1 week, 3 and 6 months after repair. RESULTS AND CONCLUSION:No significant difference in Visual Analogue Scale was detected at 1 week, 3 and 6 months after repair between the observation and control groups (P > 0.05). Oswsetry Disability Index was significantly lower in the observation group than in the control group (P < 0.05). No significant difference in the height of anterior border of injured vertebral body was detected between the observation and control groups (P > 0.05). Cobb’s angle was significantly lower in the observation group than in the control group (P < 0.05). These findings suggest that fracture reduction and pedicle screw fixation + artificial bone graft in vertebral body obtained good repair effects on Denis B thoracolumbar burst fracture, not only effectively corrected Cobb’s angle and the height of anterior border of injured vertebral body, but also helped to restore normal spinal loads by filing bone in the injured vertebral body.