經(jīng)傷椎內(nèi)固定椎間椎體內(nèi)打壓植骨治療胸腰椎骨折-論文.pdf

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1、臨床骨科雜志JournalofClinicalOrthopaedics2014Aug；17(4)·373·doi：10．3969／j．issn．1008-0287．2014．04．005·臨床論著·經(jīng)傷椎內(nèi)固定椎間椎體內(nèi)打壓植骨治療胸腰椎骨折張銀順，楊慶國，李偉，張建湘摘要：目的探討后路經(jīng)傷椎短節(jié)段復(fù)位內(nèi)固定聯(lián)合椎間椎體打壓植骨治療胸腰椎骨折的療效。方法采用經(jīng)傷椎后路復(fù)位短節(jié)段內(nèi)固定、椎間椎體內(nèi)植骨治療21例胸腰椎骨折患者。根據(jù)術(shù)前、術(shù)后1周及末次隨訪時(shí)正、側(cè)位x線片評(píng)判術(shù)后傷椎椎體前緣高度、后凸Cobb角恢復(fù)及內(nèi)固定失敗和骨融合情況。結(jié)果患者均獲隨訪，時(shí)間12～32個(gè)月。未見斷

2、釘斷棒及內(nèi)固定松動(dòng)。傷椎及椎間植骨均獲骨性愈合。傷椎椎體前緣高度：術(shù)后1周為95．1％±3．2％，末次隨訪時(shí)為93．9％±3．6％，均較術(shù)前39．6％±10．3％明顯改善(P<0．01)。損傷節(jié)段后凸Cobb角：術(shù)后1周為12．2?！?．9，末次隨訪時(shí)為12．9?！?．5。，均較術(shù)前(33．7?！?．2。)明顯恢復(fù)(P<0．01)。末次隨訪時(shí)與術(shù)后1周比較，傷椎椎體前緣高度和Cobb角均無明顯變化(P>0．05)。結(jié)論后路經(jīng)傷椎短節(jié)段內(nèi)固定聯(lián)合椎間及傷椎打壓植骨治療胸腰椎骨折，重建了椎間和椎體的穩(wěn)定性，有助于減少術(shù)后內(nèi)固定失敗及矯正丟失。關(guān)鍵詞：胸腰椎骨折；傷椎；椎弓根釘；椎間融

3、合；植骨中圖分類號(hào)：R683．2；R687．3文獻(xiàn)標(biāo)識(shí)碼：A文章編號(hào)：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