经伤椎内固定椎间椎体内打压植骨治疗胸腰椎骨折-论文.pdf

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1、临床骨科杂志JournalofClinicalOrthopaedics2014Aug；17(4)·373·doi：10．3969／j．issn．1008-0287．2014．04．005·临床论著·经伤椎内固定椎间椎体内打压植骨治疗胸腰椎骨折张银顺，杨庆国，李伟，张建湘摘要：目的探讨后路经伤椎短节段复位内固定联合椎间椎体打压植骨治疗胸腰椎骨折的疗效。方法采用经伤椎后路复位短节段内固定、椎间椎体内植骨治疗21例胸腰椎骨折患者。根据术前、术后1周及末次随访时正、侧位x线片评判术后伤椎椎体前缘高度、后凸Cobb角恢复及内固定失败和骨融合情况。结果患者均获随访，时间12～32个月。未见断

2、钉断棒及内固定松动。伤椎及椎间植骨均获骨性愈合。伤椎椎体前缘高度：术后1周为95．1％±3．2％，末次随访时为93．9％±3．6％，均较术前39．6％±10．3％明显改善(P<0．01)。损伤节段后凸Cobb角：术后1周为12．2。±2．9，末次随访时为12．9。±3．5。，均较术前(33．7。±6．2。)明显恢复(P<0．01)。末次随访时与术后1周比较，伤椎椎体前缘高度和Cobb角均无明显变化(P>0．05)。结论后路经伤椎短节段内固定联合椎间及伤椎打压植骨治疗胸腰椎骨折，重建了椎间和椎体的稳定性，有助于减少术后内固定失败及矫正丢失。关键词：胸腰椎骨折；伤椎；椎弓根钉；椎间融

3、合；植骨中图分类号：R683．2；R687．3文献标识码：A文章编号：1008—0287(2014)04—0373—04Interbodyfusionandtranspediculargraftingfollowingposteriorreductionandshort-segmentinstrumentationforthoracolumbarfractureusingpediclescrewsatthefracturelevelZ4ⅣGn-shun，YANGQing—guo，LI耽，ZHANGJian—xiang(Section口，DeptofOrthopae—dics，th

4、eFirstAffiliatedHospitalofAnhuiMedicalUniversity，Hefei，Anhui230022，China)Abstract：ObjectiveToexploretheefficacyofposteriorreductionandshort—segmentinstrumentationforthoracolum—barfractureusingpediclescrewsatthefracturelevelcombinedwithinterbodyfusionandtranspediculargrafting．Methods21patients

5、withthoracolumbarfractureweretreatedwithposteriorreductionandshort·segmentinstrumen-tationusingpediclescrewsatthefracturelevelcombinedwithinterbodyfusionandtranspediculargrafting．Theante—riorvertebralbodyheightoftheinjuredvertebra，thesegmentalCobbangle，bonegrafthealingwereassessedunderplainan

6、teroposteriorandlateralradiographsatpreoperation，one—weekafteroperation，andatthefinalfollow—up．Re-suitsAllpatientshadsolidfusionwithoutimplantfailurewithin12—32monthsoffollow—up．Theanteriorvertebralbodyheightwas95．1％±3．2％atone—weekafteroperationand93．9％±3．6％atthefinalfollow—up．Comparedwiththa

7、tatpre-operation(39．6％±10．3％)，theywerebothimprovedsignificantly(P<0．O1)．esegmentalCobbanglewere12．2。±2．9。atone-weekafteroperationand12．9。±3．5。atthefinalfollow—up．Comparedwiththatatpre—operation(33．7。4-6．2。)，theywerealsobothimprovedsignificant