伤椎单侧固定与伤椎植入液态人工骨并短节段椎弓根钉内固定治疗胸腰椎骨折的疗效比较
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摘要
目的比较短节段椎弓根钉内固定联合伤椎置钉与短节段椎弓根钉内固定联合伤椎植入液态人工骨治疗胸腰椎骨折的临床疗效。方法回顾性分析自2015-01—2017-08诊治的77例单节段胸腰椎骨折,行短节段椎弓根钉内固定,其中45例联合伤椎置钉(伤椎置钉组),32例联合伤椎植入液态人工骨(伤椎植骨组)。结果 77例均获得随访,随访时间平均19.1(15～24)个月。伤椎植骨组1例术后15个月发现伤椎高度丢失,1例术后取出内固定时发现1枚下位椎弓根钉断裂。伤椎置钉组与伤椎植骨组末次随访时疼痛VAS评分、伤椎Cobb角、伤椎椎体前缘高度比值差异无统计学意义(P>0.05)。结论伤椎置钉或伤椎植骨联合短节段椎弓根钉内固定治疗胸腰椎骨折对于恢复伤椎高度及胸腰段脊柱稳定性均有效,而AO-A3型胸腰椎骨折谨慎采用液态人工骨于伤椎植骨,建议行伤椎置钉以获得更好的远期疗效。
引文
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[11]Li Q,Yun C,Li S.Transpedicular bone grafting and pedicle screw fixation in injured vertebrae using a paraspinal approach for thoracolumbar fractures:a retrospective study[J].J Orthop Surg Res,2016,11(1):115.
[12]He D,Wu L,Sheng X,et al.Internal fixation with percutaneous kyphoplasty compared with simple percutaneous kyphoplasty for thoracolumbar burst fractures in elderly patients:a prospective randomized controlled trial[J].Eur Spine J,2013,22(10):2263.
[13]Gu YT,Zhu DH,Liu HF,et al.Minimally invasive pedicle screw fixation combined with percutaneous vertebroplasty for preventing secondary fracture after vertebroplasty[J].J Orthop Surg Res,2015,10:31.
[14]Gross RH.The use of bone grafts and bone graft substitutes in pediatric orthopaedics:an overview[J].J Pediatr Orthop,2012,32(1):100-105.
[2]Zhang C,Liu Y.Combined pedicle screw fixation at the fracture vertebrae versus conventional method for thoracolumbar fractures:a meta-analysis[J].Int J Surg,2018,53:38-47.
[3]Barbagallo GM,Yoder E,Dettori JR,et al.Percutaneous minimally invasive versus open spine surgery in the treatment of fractures of the thoracolumbar junction:a comparative effectiveness review[J].Evid Based Spine Care J,2012,3(3):43-49.
[4]晏波,杨海波.椎弓根钉内固定联合PVP或PKP治疗骨质疏松性胸腰椎爆裂骨折[J].中国骨与关节损伤杂志,2018,33(7):720-721.
[5]王遥伟,王树金,孔丹辉,等.胸腰椎骨折经伤椎短节段椎弓根钉内固定疗效分析[J].中国骨与关节损伤杂志,2016,31(3):228-230.
[6]Schmid R,Lindtner RA,Lill M,et al.Combined posteroanterior fusion versus transforaminal lumbar interbody fusion(TLIF)in thoracolumbar burst fractures[J].Injury,2012,43(4):475-479.
[7]Alanay A,Acaroglu E,Yazici M,et al.Short-segment pedicle instrumentation of thoracolumbar burst fractures:does transpedicular intracorporeal grafting prevent early failure?[J].Spine(Phila Pa1976),2001,26(2):213-217.
[8]Guven O,Kocaoglu B,Bezer M,et al.The use of screw at the fracture level in the treatment of thoracolumbar burst fractures[J].JSpinal Disord Tech,2009,22(6):417-421.
[9]Wu H,Wang CX,Gu CY,et al.Comparison of three different surgical approaches for treatment of thoracolumbar burst fracture[J].Chin J Traumatol,2013,16(1):31-35.
[10]齐志远,陈秀民,王在斌,等.短节段经伤椎单侧置钉固定与其结合椎体内植骨治疗胸腰椎骨折的疗效比较[J].中国骨与关节损伤杂志,2015,30(1):28-30.
[11]Li Q,Yun C,Li S.Transpedicular bone grafting and pedicle screw fixation in injured vertebrae using a paraspinal approach for thoracolumbar fractures:a retrospective study[J].J Orthop Surg Res,2016,11(1):115.
[12]He D,Wu L,Sheng X,et al.Internal fixation with percutaneous kyphoplasty compared with simple percutaneous kyphoplasty for thoracolumbar burst fractures in elderly patients:a prospective randomized controlled trial[J].Eur Spine J,2013,22(10):2263.
[13]Gu YT,Zhu DH,Liu HF,et al.Minimally invasive pedicle screw fixation combined with percutaneous vertebroplasty for preventing secondary fracture after vertebroplasty[J].J Orthop Surg Res,2015,10:31.
[14]Gross RH.The use of bone grafts and bone graft substitutes in pediatric orthopaedics:an overview[J].J Pediatr Orthop,2012,32(1):100-105.