后路椎弓根螺钉固定结合经椎弓根植骨治疗胸腰段骨折的临床研究
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摘要
目的：
探讨经后路椎弓根螺钉复位内固定结合经椎弓根伤椎内植骨治疗胸腰段骨折的临床疗效。
方法：
回顾性分析2005年1月-2009年7月同一组医师手术治疗的63例胸腰段骨折患者,其中28例接受了椎弓根螺钉内固定结合经椎弓根伤椎内植骨手术,同期35例采用了椎弓根螺钉内固定结合后外侧植骨融合术作为对照。经过8-34个月随访,通过比较两组：术前、术后及最终随诊时,伤椎前、后缘高度比值、脊柱后凸成角(Cobb角)变化、神经功能Franke1等级改变、腰背疼痛(VAS)评分改善等指标,评价后路椎弓根螺钉复位内固定结合经椎弓根伤椎内植骨治疗胸腰段骨折的临床效果。
结果：
术前两组伤椎前、后缘高度比值和Cobb角比较无明显差异,通过手术复位固定后,经椎弓根伤椎内植骨组椎体前缘高度比值由42.2%增加至94.2%,Cobb角由术前的24.1°减小到6.5°,对照组椎体前缘高度比值由44.1%增加至93.7%,Cobb角由术前的18.3°减小到7.5°,两组术后结果与术前比较椎体高度恢复理想,后凸成角畸形矫正明显。最终随诊时(平均17.3月后),伤椎内植骨组椎体前缘高度比值为92.1%,Cobb角矫正度为7.6°均优于对照组(86.1%、12.1°),两组比较差异显著具有统计学意义(P<0.05)。腰背疼痛VAS评分最终改善情况：伤椎内植骨组改善6.7±1.5分,对照组VAS评分改善为5.9±1.3分,两组比较差异有统计学意义(P<0.05),伤椎内植骨组优于对照组。Franke1分级神经功能最终改善情况：经椎弓根伤椎内植骨组神经功能无改变13例,提高1级有10例患者,提高2级有4例患者,提高3级有1例患者；对照组神经功能无改变17例,提高1级有12例患者,提高2级有5例患者,提高3级有1例患者,伤椎内植骨组略优于对照组,但两组比较差异无统计学意义(P>0.05)。
结论：
后路椎弓根螺钉内固定结合经椎弓根伤椎内植骨能充分恢复伤椎的高度,矫正脊柱后凸畸形；并能减少椎体高度和后凸矫正角度丢失,避免长期腰背疼痛发生。
Objective:
To evaluate the clinical results of the treatment of thoracolumbar fractures with posterior pedicle screw fixation and transpedicular intrabody grafting.
Methods:
Sixty-three cases of thoracohmbar fractures were treated surgically since January 2005 to July 2009.28 patients received posterior pedicle screw fixation combined with bone graft surgery, and 37 cases which with posterior pedicle screw fixation were used as control group.To evaluate the clinical results of the treatment of thoracolumbar fractures with posterior pedicle screw fixation and transpedicular intrabody grafting,the correction of height of injured vertebrae and angular kyphosis (Cobb angulation), the recovery of neurologic deficit, Frankel classification, and the complication of low back pain of the two groups were assessed before and after operation and during follow-up. The mean follow-up time was 17.3 months(8-34 months).
Results:
The height and Cobb angulation were similar between two groups before operation and no significant statistical diference(P>0.05). Through surgery, anterior vertebral height ratio of the group interbody bone grafting increased from 42.2% to 94.2%,Cobb angulation from 24.1°reduced to 6.5°,and anterior vertebral height ratio of the control group increased from 44.1% to 93.7%, Cobb angulation was 18.3°before surgery reduced to 7.5°. Compared with the preoperative vertebral body height, kyphosis correction of angular deformities, surgical results were satisfactory. Anterior vertebral height ratio was 92.1% and Cobb angulation was 7.6°of the observer group which were better than the control group(86.1%、12.1°) when eventually followed up(The mean was 17.3 months),difference between the two groups was statistically significant (P<0.05). The Interbody bone grafting group reduce low back pain better than the control group,VAS score were 6.7±1.5 and 5.9±1.3, and difference was statistically significant (P<0.05). Frankel classification were improved to some extent in both groups, but the difference between two groups was not significant (P> 0.05).The interbody bone grafting group in 13 cases have no changed in neurological function and improved 1 degree of 10 cases, improved 2degree of 4 cases, improved 3 degrees of 1 case.The control group have 17 no changed cases and 12 cases improved 1 degree,5 cases improved 2 degree,1 case improved 3 degrees.
Conclusion:
The results of treatment of thoracolumbar fracture with posterior pedicle screw fixation and transpedicular intrabody grafting are good. This procedure can prevent the loss of correction and decrease the complication of low back pain after operation.
探讨经后路椎弓根螺钉复位内固定结合经椎弓根伤椎内植骨治疗胸腰段骨折的临床疗效。
方法：
回顾性分析2005年1月-2009年7月同一组医师手术治疗的63例胸腰段骨折患者,其中28例接受了椎弓根螺钉内固定结合经椎弓根伤椎内植骨手术,同期35例采用了椎弓根螺钉内固定结合后外侧植骨融合术作为对照。经过8-34个月随访,通过比较两组：术前、术后及最终随诊时,伤椎前、后缘高度比值、脊柱后凸成角(Cobb角)变化、神经功能Franke1等级改变、腰背疼痛(VAS)评分改善等指标,评价后路椎弓根螺钉复位内固定结合经椎弓根伤椎内植骨治疗胸腰段骨折的临床效果。
结果：
术前两组伤椎前、后缘高度比值和Cobb角比较无明显差异,通过手术复位固定后,经椎弓根伤椎内植骨组椎体前缘高度比值由42.2%增加至94.2%,Cobb角由术前的24.1°减小到6.5°,对照组椎体前缘高度比值由44.1%增加至93.7%,Cobb角由术前的18.3°减小到7.5°,两组术后结果与术前比较椎体高度恢复理想,后凸成角畸形矫正明显。最终随诊时(平均17.3月后),伤椎内植骨组椎体前缘高度比值为92.1%,Cobb角矫正度为7.6°均优于对照组(86.1%、12.1°),两组比较差异显著具有统计学意义(P<0.05)。腰背疼痛VAS评分最终改善情况：伤椎内植骨组改善6.7±1.5分,对照组VAS评分改善为5.9±1.3分,两组比较差异有统计学意义(P<0.05),伤椎内植骨组优于对照组。Franke1分级神经功能最终改善情况：经椎弓根伤椎内植骨组神经功能无改变13例,提高1级有10例患者,提高2级有4例患者,提高3级有1例患者；对照组神经功能无改变17例,提高1级有12例患者,提高2级有5例患者,提高3级有1例患者,伤椎内植骨组略优于对照组,但两组比较差异无统计学意义(P>0.05)。
结论：
后路椎弓根螺钉内固定结合经椎弓根伤椎内植骨能充分恢复伤椎的高度,矫正脊柱后凸畸形；并能减少椎体高度和后凸矫正角度丢失,避免长期腰背疼痛发生。
Objective:
To evaluate the clinical results of the treatment of thoracolumbar fractures with posterior pedicle screw fixation and transpedicular intrabody grafting.
Methods:
Sixty-three cases of thoracohmbar fractures were treated surgically since January 2005 to July 2009.28 patients received posterior pedicle screw fixation combined with bone graft surgery, and 37 cases which with posterior pedicle screw fixation were used as control group.To evaluate the clinical results of the treatment of thoracolumbar fractures with posterior pedicle screw fixation and transpedicular intrabody grafting,the correction of height of injured vertebrae and angular kyphosis (Cobb angulation), the recovery of neurologic deficit, Frankel classification, and the complication of low back pain of the two groups were assessed before and after operation and during follow-up. The mean follow-up time was 17.3 months(8-34 months).
Results:
The height and Cobb angulation were similar between two groups before operation and no significant statistical diference(P>0.05). Through surgery, anterior vertebral height ratio of the group interbody bone grafting increased from 42.2% to 94.2%,Cobb angulation from 24.1°reduced to 6.5°,and anterior vertebral height ratio of the control group increased from 44.1% to 93.7%, Cobb angulation was 18.3°before surgery reduced to 7.5°. Compared with the preoperative vertebral body height, kyphosis correction of angular deformities, surgical results were satisfactory. Anterior vertebral height ratio was 92.1% and Cobb angulation was 7.6°of the observer group which were better than the control group(86.1%、12.1°) when eventually followed up(The mean was 17.3 months),difference between the two groups was statistically significant (P<0.05). The Interbody bone grafting group reduce low back pain better than the control group,VAS score were 6.7±1.5 and 5.9±1.3, and difference was statistically significant (P<0.05). Frankel classification were improved to some extent in both groups, but the difference between two groups was not significant (P> 0.05).The interbody bone grafting group in 13 cases have no changed in neurological function and improved 1 degree of 10 cases, improved 2degree of 4 cases, improved 3 degrees of 1 case.The control group have 17 no changed cases and 12 cases improved 1 degree,5 cases improved 2 degree,1 case improved 3 degrees.
Conclusion:
The results of treatment of thoracolumbar fracture with posterior pedicle screw fixation and transpedicular intrabody grafting are good. This procedure can prevent the loss of correction and decrease the complication of low back pain after operation.
引文
1. Ertiirer E, Tezer M, Ozturk I, Kuzgun U.Evaluation of vertebral fractures and associated injuries in adults Acta Orthop Traumatol Turc.2005;39(5):387-90.
2. Reinhold M, Knop C, Lange U, Bastian L, Blauth M. Non-operative treatment of thoracolumbar spinal fractures. Long-term clinical results over 16 years Unfallchirurg.2003 Jul;106(7):566-76.
3. Roy-Camille R, Saillant G, Mazel C. Plating of thoracic, thoracolumbar, and lumbar injuries with pedicle screw plates. Orthop Clin North Am,1986; 17: 147-159
4. Flamme CH, Hurschler C, Heymann C, et al. Comparative biomechanical testing of anterior and posterior stabilization procedures. Spine.2005;30(13):352-62.
5. Parker JW,Lane JR,Karaikovic EE, et al.Successful short-segment instrument-ation and fusion for thoracolumbar spine fractures:a consecutive 41/2-year series. Spine,2000;25:1157-1170.
6. Dick W. The fixateur inteme as a versatile implant spine surgery[J]. Spine.1987;12:882-889.
7. Watkins MB. Posterior fusion of the lumbar and lumbosacral spine [J]. J Bone Joint Surg(Am).1953;35:1014-1018.
8. McLain RF, Sparling E,Benson DR. Early failure of shortsegment pedicle instrumentation for thoracolumbar fractures:a p reliminary report [J]. J Bone Joint Surg (Am).1993;75 (2):162-167.
9. Qian BP, Qiu Y, Wang B et al. Effect of posterolateral fusion on thoracolumbar burst fractures. Chin J Traumatol.2006;9(6):349-55
10. Dean SM,Hall BB,Johnson RG. Analysis of posterolateral lumbar fusion and VSP pedicle screw and plate fixation [J]. Orthop Trans.1990;14:664.
11. McGuire RA,Amundson GM. The use of primary internal fixation in spondylolisthesis[J]. Spine,1993,18:1662.
12. Schoferman J, Slosar P, Reynolds J, et al. A prespective randomized comparison of 270 degrees fusions to 360 degrees fusion(circumferential fusions) J. Spine.2001;26(10):207-212.
13.张贵林,荣国威,丁占云,等。脊柱胸腰段骨折术后椎弓根螺钉断裂及弯曲松动的原因分析中华骨科杂志,2000；20(8)：470-472.
14. Muller U, Berlemann U, Sledge J, et al. Treatment of thoracolumbar burst
fractures without neurologic deficit by indirect reduction and posterior instrumentation:bisegmental stabilization with monosegmental fusion. Eur Spine J,1999,8:284-289
15. Daniaux H. Transpedicular repositioning and spongioplasty in fractures of the vertebral bodies of the lower thoracic and lumbar spine[J]. Unfallchirurg, 1986;89(5):197-213.
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1. Ertiirer E, Tezer M, Ozturk I, Kuzgun U. Evaluation of vertebral fractures and associated injuries in adults Acta Orthop Traumatol Turc.2005;39(5):387-90.
2. Roy-Camille R, Saillant G, Mazel C. Plating of thoracic thoracolumbar and lumbar injuries with pedicle screw plates. Orthop Clin North Am.1986;17:147-159
3. Yue JJ, Sossan A, Selgrath C, et al. The treatment of unstable thoracic spine fractures with transpedicular screw instrumentation:a 3-year consecutive series. Spine.2002;27:2782-2787
4. Flamme CH, Hurschler C, Heymann C, et al. Comparative biomechanical testing of anterior and posterior stabilization procedures. Spine.2005;30(13):352-62.
5. Panjabi MM, Kifune M, Wen L, et al. Dyanmic canal encroachment during thoracolumbar burst fracture[J]. J Spinal Disord.1995;8(1):39-48.
6. Boerger TO, Limb D, Dickson RA. Does'canal clearance'affect neurological outcome after thoracolumbar burst fractures.'?[J]. J Bone Joint Surg Br. 2000;82(5):629-635.
7. 戴力扬。胸腰椎爆裂性骨折的诊断[J],临床骨科杂志。2001;4(1)：67-69。
8. Edwords CC, Levime AM. Early rod-sleeve stabitization of the injuried thoracic and lumbar spine. Orthop Clin North Am.1986;17 (1):121
9. McLain RF, Sparling E, Benson DR. Early failure of shortsegment pedicle instrumentation for thoracolumbar fractures:a preliminary report [J]. J Bone Joint Surg (Am).1993;75 (2):162-167.
10.钱邦平,邱勇,王斌,等。后外侧融合对胸腰椎爆裂型骨折疗效的影响[J]。中华创伤杂志。2006；22(2)：121-125。
11.张贵林,荣国威,丁占云,等。脊柱胸腰段骨折术后椎弓根螺钉断裂及弯曲松动的原因分析中华骨科杂志,2000；20(8)：470-472。
12. Schoferman J, Slosar P, Reynolds J, et al. A prespective randomized comparison of 270 degrees fusions to 360 degrees fusion(circumferential fusions) J. Spine. 2001;26(10):207-212.
13. Muller U, Berlemann U, Sledge J, et al. Treatment of thoracolumbar burst fractures without neurologic deficit by indirect reduction and posterior instrumentation:bisegmental stabilization with monosegmental fusion. Eur Spine J.1999;8:284-289.
14.刘团江,郝定均,王晓东,等。胸腰段骨折椎弓根钉复位固定术后骨缺损的CT研究[J]。中国矫形外科杂志,2003；10：706-707。
15. Biedermann L. Biomechanics of pedicle fixation as related to implant design. Presented at the.American-European Meeting on Pedicle fixation of the spine and Other Advanced Techniques. Munich; 1994:115-118.
16. Mermelstein LE, McLain RF, Yerby SA. Reinforcement of thoracolumbar burst fractures with calcium phosphate cement. A biomechanical study. Spine. 1998;23(6):664-670.
17. Daniaux H. Transpedicular repositioning and spongioplasty in fractures of the vertebral bodies of the lower thoracic and lumbar spine[J]. Unfallchirurg, 1986;89(5):197-213.
18. Walchli B, Heini P, Berlemann U. Loss of correction after dorsal stabilization of bunt fractures of the thoracolumbar junction. The role of transpedicular spongiosa plasty. Unfallchirurg 2001;104:742-747.
19. Toyone T, Tanaka T, Kato D, et al. The treatment of acute thoracolumbar burst fractures with transpedicular intracorporeal hydroxyapatite grafting following indirect reduction and pedicle screw fixation:a prospective study[J]. Spine, 2006;31(7):E208-214.
2. Reinhold M, Knop C, Lange U, Bastian L, Blauth M. Non-operative treatment of thoracolumbar spinal fractures. Long-term clinical results over 16 years Unfallchirurg.2003 Jul;106(7):566-76.
3. Roy-Camille R, Saillant G, Mazel C. Plating of thoracic, thoracolumbar, and lumbar injuries with pedicle screw plates. Orthop Clin North Am,1986; 17: 147-159
4. Flamme CH, Hurschler C, Heymann C, et al. Comparative biomechanical testing of anterior and posterior stabilization procedures. Spine.2005;30(13):352-62.
5. Parker JW,Lane JR,Karaikovic EE, et al.Successful short-segment instrument-ation and fusion for thoracolumbar spine fractures:a consecutive 41/2-year series. Spine,2000;25:1157-1170.
6. Dick W. The fixateur inteme as a versatile implant spine surgery[J]. Spine.1987;12:882-889.
7. Watkins MB. Posterior fusion of the lumbar and lumbosacral spine [J]. J Bone Joint Surg(Am).1953;35:1014-1018.
8. McLain RF, Sparling E,Benson DR. Early failure of shortsegment pedicle instrumentation for thoracolumbar fractures:a p reliminary report [J]. J Bone Joint Surg (Am).1993;75 (2):162-167.
9. Qian BP, Qiu Y, Wang B et al. Effect of posterolateral fusion on thoracolumbar burst fractures. Chin J Traumatol.2006;9(6):349-55
10. Dean SM,Hall BB,Johnson RG. Analysis of posterolateral lumbar fusion and VSP pedicle screw and plate fixation [J]. Orthop Trans.1990;14:664.
11. McGuire RA,Amundson GM. The use of primary internal fixation in spondylolisthesis[J]. Spine,1993,18:1662.
12. Schoferman J, Slosar P, Reynolds J, et al. A prespective randomized comparison of 270 degrees fusions to 360 degrees fusion(circumferential fusions) J. Spine.2001;26(10):207-212.
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