经伤椎椎弓根螺钉固定联合经伤椎椎弓根植骨治疗胸腰椎骨折的效果观察.docVIP

经伤椎椎弓根螺钉固定联合经伤椎椎弓根植骨治疗胸腰椎骨折的效果观察 　　[摘要]目的 探?经伤椎椎弓根钉固定联合经伤椎椎弓根椎体内植骨治疗胸腰椎骨折的效果。方法 回顾性分析我院2011年9月～2015年8月收治的109例胸腰椎骨折患者，根据治疗方法的不同分为A组（49例）和B组（60例）。A组采用单纯经伤椎椎弓根钉固定，B组采用经伤椎椎弓根钉固定联合经伤椎椎弓根椎体内植骨。术后随访8～29个月，平均随访15.1个月。比较两组术前、术后及末次随访数字射线摄影（DR）侧位片上测量的伤椎前缘高度压缩比、伤椎相邻椎Cobb角，记录两组的手术时间、手术出血量及手术并发症。结果 B组的手术时间长于A组，出血量多于A组，差异有统计学意义（P0.05）。两组术前、术后的伤椎前缘高度压缩比、Cobb角比较，差异无统计学意义（P0.05）。B组末次随访的伤椎前缘高度压缩比大于A组，Cobb角小于A组，差异有统计学意义（P0.05）。A组有1例断钉，1例螺钉松动椎体高度后凸角度丢失，出现神经压迫症状需再次手术；B组无螺钉松动、无断钉。结论 在胸腰椎骨折经伤椎椎弓根钉固定联合经伤椎椎弓根椎体内植骨治疗术中，经伤椎置钉可较好地恢复椎体高度，纠正后凸畸形角度；同时联合经伤椎弓根椎体内植骨，可减少远期螺钉松动、断钉及椎体高度、Cobb角丢失等并发症。 　　[关键词]胸腰椎骨折；伤椎；固定；椎弓根钉；植骨 　　[中图分类号] R683.2 [文献标识码] A [文章编号] 1674-4721（2017）10（a）-0107-04 　　[Abstract]Objective To explore the clinical efficacy of pedicle screw fixation combined with transpedicular bone grafting in the treatment of thoracolumbar fractures.Methods Clinical data of 109 cases with thoracolumbar fracture from September 2011 to August 2015 in our hospital were retrospectively analyzed，all patients were divided into group A （49 cases） and group B （60 cases） according to different treatment methods.Group A was treated with simple pedicle screw fixation，and group B was treated with the pedicle screw fixation of the fractured vertebra combined with transpedicular bone grafting of the injured vertebra.All patients were followed up for 8-29 months，the mean follow-up was 15.1 months.The compression ratio of the leading edge height of the injured vertebra，the adjacent vertebral Cobb angle in digital radiography （DR） preoperative，postoperative and final follow-up in the two groups were compared.Operation time，blood loss and complications in the two groups were recorded.Results The operation time of group B was longer than that of group A，and the amount of bleeding of group B was more than that of group A，with significant difference （P0.05）.There was no significant difference in the compression ratio of the leading edge height of the injured vertebra and the angle of Cobb before operation and after