经后路椎体次全切除术联合椎间支撑植骨治疗胸腰椎爆裂性骨折的疗效与安全性分析
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摘要
目的探究椎间支撑植骨联合经后路椎体次全切除术治疗胸腰椎爆裂性骨折的临床疗效。方法回顾性分析2012年1月—2015年1月南京梅山医院骨科收治的65例胸腰椎爆裂性骨折患者临床资料,其中男性30例,女性35例;平均年龄(63. 4±4. 6)岁。所有患者行后路椎体次全切除术联合椎间支撑植骨治疗,观察患者手术时间、术中出血量和术后指标;比较治疗不同时间点(术前、出院时、末次随访) VAS和健康状况调查简表(SF-36)分数以及术前、出院时和末次随访时的Cobb角和椎体高度压缩率。结果所有患者顺利完成手术,平均手术时间(182. 5±42. 6) min,平均术中出血量(327. 9±75. 8) mL,术后平均住院时间(7. 5±1. 7) d,平均骨折愈合时间(7. 4±1. 1)个月,平均随访时间(13. 8±2. 5)个月,内固定平均拆除时间(10. 5±1. 2)个月。与术前相比,出院时和末次随访时患者的VAS评分下降(P <0. 05)。与术前和出院时相比,末次随访时患者的SF-36评分增加(P <0. 05)。术前患者平均Cobb角为(23. 5±4. 8)°,出院时为(5. 4±1. 4)°,差异有统计学意义(P <0. 05),末次随访时为(5. 8±1. 1)°,增加(0. 4±0. 1)°,与出院时相比差异无统计学意义(P> 0. 05)。术前椎体高度压缩率为(57. 6±7. 0)%,出院时恢复至(96. 5±3. 2)%,差异有统计学意义(P <0. 05),末次随访时为(95. 2±4. 1)%,丢失(1. 3±0. 4)%,与出院时相比差异无统计学意义(P> 0. 05)。结论经后路椎体次全切除术联合椎间支撑植骨治疗胸腰椎爆裂性骨折效果显著,安全性高,值得临床推广。
Objective To explore the clinical effect of posterior subtotal vertebrectomy combined with intervertebral bone graft in the treatment of thoracolumbar burst fracture. Methods Sixty-five cases of thoracolumbar burst fracture from Jan. 2012 to Jan. 2015 in Department of Orthopedics of Nanjing Meishan Hospital were selected.There were 30 males and 35 females and the mean age was( 63. 4 ± 4. 6) years. They were given the operation of posterior subtotal vertebrectomy combined with intervertebral bone graft. The operation time,intraoperative bleeding volume and postoperative indicators,VAS and SF-36 scores at different time of treatment( before operation,at discharge and the last follow-up),Cobb's angle and vertebral height compression rate before treatment,at discharge and the last follow-up were recorded. Results All operations were performed successfully. The average operation time was( 182. 5 ± 42. 6) min; the average bleeding volume was( 327. 9 ± 75. 8) m L; the average postoperative hospitalization time was( 7. 5 ± 1. 7) d; the average fracture healing time was( 7. 4 ± 1. 1) months; the average followup time was( 13. 8 ± 2. 5) months; the removal time of internal fixation was( 10. 5 ± 1. 2) months. There was no serious complication during the follow-up period. The postoperative VAS scores were significantly lower than preoperatively( P < 0. 05); the postoperative SF-36 scores were significantly lower than preoperatively( P < 0. 05). The Cobb's angles after operations were significantly lower than before operation( 23. 5 ± 4. 8°) vs.( 5. 4 ± 1. 4) °( P <0. 05),and there was no significant difference in Cobb's angles between the end of follow-up and immediate time after surgery. The vertebral height compression ratios after operation were significantly higher than before operation( P < 0. 05),and there was no significant difference of vertebral height compression ratios between the end of followup and immediately after surgery. Conclsuion The effect of posterior subtotal vertebrectomy combined with intervertebral bone graft in the treatment of thoracolumbar burst fracture is excellent.
Objective To explore the clinical effect of posterior subtotal vertebrectomy combined with intervertebral bone graft in the treatment of thoracolumbar burst fracture. Methods Sixty-five cases of thoracolumbar burst fracture from Jan. 2012 to Jan. 2015 in Department of Orthopedics of Nanjing Meishan Hospital were selected.There were 30 males and 35 females and the mean age was( 63. 4 ± 4. 6) years. They were given the operation of posterior subtotal vertebrectomy combined with intervertebral bone graft. The operation time,intraoperative bleeding volume and postoperative indicators,VAS and SF-36 scores at different time of treatment( before operation,at discharge and the last follow-up),Cobb's angle and vertebral height compression rate before treatment,at discharge and the last follow-up were recorded. Results All operations were performed successfully. The average operation time was( 182. 5 ± 42. 6) min; the average bleeding volume was( 327. 9 ± 75. 8) m L; the average postoperative hospitalization time was( 7. 5 ± 1. 7) d; the average fracture healing time was( 7. 4 ± 1. 1) months; the average followup time was( 13. 8 ± 2. 5) months; the removal time of internal fixation was( 10. 5 ± 1. 2) months. There was no serious complication during the follow-up period. The postoperative VAS scores were significantly lower than preoperatively( P < 0. 05); the postoperative SF-36 scores were significantly lower than preoperatively( P < 0. 05). The Cobb's angles after operations were significantly lower than before operation( 23. 5 ± 4. 8°) vs.( 5. 4 ± 1. 4) °( P <0. 05),and there was no significant difference in Cobb's angles between the end of follow-up and immediate time after surgery. The vertebral height compression ratios after operation were significantly higher than before operation( P < 0. 05),and there was no significant difference of vertebral height compression ratios between the end of followup and immediately after surgery. Conclsuion The effect of posterior subtotal vertebrectomy combined with intervertebral bone graft in the treatment of thoracolumbar burst fracture is excellent.
引文
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[2]王洪,易小波,任志宏,等.后路单侧侧前方减压钛网重建结合椎弓根钉内固定治疗胸腰椎爆裂骨折[J].中国骨与关节损伤杂志,2012,27(11):987-989.
[3]殷作明,林秀来,李素芝,等.后路单侧侧前方椎体次全切除钛网重建椎体治疗高原胸腰椎爆裂骨折[J].创伤外科杂志,2010,12(1):28-31.
[4]刘海燕,张向荣,刘剑飞,等.后路椎弓根钉固定椎体次全切除钛网植骨融合治疗严重胸腰椎骨折[J].中医正骨,2014,26(2):38-40.
[5]庄全魁,陈勇,李杨,等.后路椎体次全切除椎间支撑植骨治疗胸腰椎爆裂骨折疗效观察[J].蚌埠医学院学报,2014,39(9):1223-1225.
[6]孙志波,禹志宏,邹海兵,等.后路椎体次全切钛网植骨融合内固定治疗胸腰椎爆裂骨折[J].中国骨与关节损伤杂志,2013,28(1):55-56.
[7]沈皆亮,郝杰,胡侦明,等.后路椎体次全切钛网植入内固定治疗胸腰椎爆裂骨折[J].创伤外科杂志,2015,17(5):430-433.
[8]蒙德.棘突截骨钛网椎管成形术在胸腰椎骨折治疗中的应用研究[J].岭南现代临床外科,2014,14(6):672-674.
[9]张东泉,王炜,刘荣财,等.经侧后方椎体次全切除减压支撑植骨治疗胸腰椎爆裂骨折[J].中国骨伤,2011,24(7):553-556.
[10]高博,幸嵘,孔清泉,等.经后路椎体次全切除加椎间支撑植骨治疗胸腰椎爆裂性骨折及骨折脱位的早期疗效观察[J].中国修复重建外科杂志,2012,26(5):542-545.
[11]王庆德,梅伟,王祥善,等.一期后路椎体次全切除、钛网植骨治疗陈旧性胸腰椎爆裂性骨折[J].医药论坛杂志,2011,32(21):127-128.
[12]侯力强,李建军,冷燕奎,等.后路椎体次全切钛网植骨重建治疗胸腰椎爆裂性骨折[J].临床骨科杂志,2011,14(1):22-24.