經(jīng)單側(cè)椎管植骨治療胸腰椎骨折去除內(nèi)固定后回顧性分析
發(fā)布時(shí)間：2019-05-18 04:54
【摘要】：目的:探討經(jīng)后路單側(cè)椎管傷椎植骨治療胸腰椎骨折去除內(nèi)固定后臨床療效,為臨床治療胸腰椎骨折提供初步可行性依據(jù)。方法:收集我科于2013年9月~2014年10月期間收治60例胸腰椎骨折手術(shù)取出內(nèi)固定術(shù)患者病例。經(jīng)查病歷資料,所有患者均采用“后路傷椎骨折撐開復(fù)位,自體骨混合同種異體骨顆粒經(jīng)單側(cè)椎管椎體內(nèi)植骨,椎管探查減壓,椎弓根釘棒系統(tǒng)內(nèi)固定術(shù)”,分別于手術(shù)前、術(shù)后、取出內(nèi)固定后末次隨訪時(shí)拍攝傷椎節(jié)段X線正側(cè)位片、CT平掃+三維重建檢查,測量傷椎椎體前緣高度丟失率、椎間隙高度變化、脊柱矢狀面Cobb角進(jìn)行統(tǒng)計(jì)學(xué)分析,統(tǒng)計(jì)手術(shù)前、手術(shù)后24小時(shí)及末次隨訪時(shí)行疼痛視覺模擬評分(Visual Analogue Score,VAS)評分,觀察患者術(shù)前及末次隨訪日本骨科協(xié)會評分(Japanese Orthopedics Association)JOA評分,針對存在神經(jīng)損傷患者采用Frankel分級法評估手術(shù)前及末次隨訪時(shí)神經(jīng)功能學(xué)恢復(fù)情況。各項(xiàng)數(shù)據(jù)以SPSS17.0軟件處理。結(jié)果:60例患者均獲得隨訪,男性患者32例,女性患者28例,經(jīng)20~26個(gè)月隨訪,平均23.5個(gè)月。術(shù)后療效評估包括:椎體前緣高度丟失率、椎間隙高度變化、脊柱矢狀面Cobb角、VAS分值、JOA評分分值及神經(jīng)功能恢復(fù)情況。骨折愈合時(shí)間約12周,平均14.5周。住院期間觀察指標(biāo)結(jié)果:脊柱矢狀面Cobb角由術(shù)前(31.22±9.00)°恢復(fù)到術(shù)后的(4.13±1.33)°,傷椎前緣高度丟失率比由術(shù)前(50.23±11.01)%降到術(shù)后的(4.78±1.97)%。VAS評分由術(shù)前(6.39±1.50)分下降到(2.30±0.89)分以及JOA評分(10.33±2.94)。末次隨訪統(tǒng)計(jì)指標(biāo)結(jié)果:脊柱矢狀面Cobb角(4.42±1.33)°、椎體前緣高度丟失率(4.79±1.74)%、VAS評分(1.71±0.77)分、JOA評分(21.92±3.56)分,手術(shù)前19例合并神經(jīng)功能損傷患者中由術(shù)前Frankel A級3例,B級4例,C級2例,D級10例(注:E級為正常)恢復(fù)到A級0例,B級2例,C級0例D級4例。術(shù)后脊髓神經(jīng)功能損害無加重病例、未出現(xiàn)內(nèi)固定器移位、斷裂等情況,經(jīng)統(tǒng)計(jì)學(xué)分析:1、手術(shù)前及手術(shù)后比較Cobb角改變、傷椎前緣高度丟失率、椎間隙高度變化、VAS評分分值差異有統(tǒng)計(jì)學(xué)意義(P0.05);2、手術(shù)前與末次隨訪時(shí)相比較Cobb角改變、傷椎椎體前緣高度丟失率、椎間隙高度變化、VAS評分分值及JOA評分分值差異有統(tǒng)計(jì)學(xué)意義(P0.05);3、術(shù)后及末次隨訪相比較:Cobb角、傷椎前緣高度丟失率、椎間隙高度差異無統(tǒng)計(jì)學(xué)意義(P0.05);4、手術(shù)后與末次隨訪時(shí)比較VAS評分分值差異有統(tǒng)計(jì)學(xué)意義(P0.05);5、末次隨訪神經(jīng)功能Frankel分級評估較術(shù)前有明顯的改善,差異有統(tǒng)計(jì)學(xué)意義(Z=-3.834,P0.05)。結(jié)論:經(jīng)椎弓根螺釘撐開復(fù)位固定椎板間隙開窗單側(cè)椎管椎體內(nèi)植骨治療胸腰椎骨折,傷椎復(fù)位好,骨折愈合可,術(shù)后神經(jīng)功能恢復(fù)滿意,后凸矯正后能加強(qiáng)脊柱的穩(wěn)定性。
[Abstract]:Objective: to investigate the clinical effect of posterior unilateral spinal canal bone grafting in the treatment of thoracolumbar fractures after removal and internal fixation, and to provide preliminary feasible basis for clinical treatment of thoracolumbar fractures. Methods: from September 2013 to October 2014, 60 patients with thoracolumbar fractures were treated with internal fixation. According to the medical records, all patients were treated with "posterior vertebral fracture open reduction, autologous bone mixed with allogenic bone particles through unilateral vertebral canal bone grafting, spinal canal exploration and decompression, pedicle screw rod system internal fixation", respectively, before the operation, the patients were treated with posterior vertebral fracture open reduction, autologous bone mixed with allogenic bone particles through unilateral vertebral canal internal bone grafting, spinal canal exploration and decompression, and pedicle screw rod system internal fixation. After operation, the X-ray positive and lateral radiography of the injured vertebrae were taken at the last follow-up after internal fixation, and the three-dimensional reconstruction of the injured vertebrae was examined by CT plain scan. The loss rate of the anterior edge of the injured vertebrae, the height of the intervertebral space and the Cobb angle of the sagittal plane of the injured vertebrae were statistically analyzed. The scores of pain visual analog score (Visual Analogue Score,VAS) before operation, 24 hours after operation and the last follow-up were counted, and the (Japanese Orthopedics Association) JOA scores of patients before and after the last follow-up were observed. Frankel grading method was used to evaluate the recovery of neurological function before operation and at the last follow-up. Each data is processed by SPSS17.0 software. Results: all the 60 patients were followed up, 32 males and 28 females, with an average of 23.5 months. The postoperative evaluation included the loss rate of vertebral anterior edge height, the change of intervertebral space height, the sagittal Cobb angle, VAS score, JOA score and neurological function recovery. The fracture healing time was about 12 weeks, with an average of 14.5 weeks. The results of observation during hospitalization showed that the Cobb angle of sagittal plane of spine recovered from (31.22 鹵9.00) 擄before operation to (4.13 鹵1.33) 擄after operation. The ratio of height loss of anterior edge of injured vertebrae decreased from (50.23 鹵11.01)% before operation to (4.78 鹵1.97)% after operation. VAS score decreased from (6.39 鹵1.50) to (2.30 鹵0.89) and JOA score (10.33 鹵2.94). The statistical results of the last follow-up showed that the Cobb angle of the sagittal plane of the spine was (4.42 鹵1.33) 擄, the loss rate of the anterior edge of the vertebral body was (4.79 鹵1.74)%, the VAS score was (1.71 鹵0.77), and the JOA score was (21.92 鹵3.56). Among the 19 patients with neurological injury before operation, there were 3 cases of Frankel grade A, 4 cases of grade B, 2 cases of grade C, 10 cases of grade D (note: grade E was normal) to 0 cases of grade A, 2 cases of grade B and 4 cases of grade D of grade C. There was no aggravation of spinal cord nerve function damage after operation, and there was no displacement and fracture of internal fixation. 1. The changes of Cobb angle, the loss rate of anterior edge of injured vertebrae and the height of intervertebral space were compared before and after operation. The difference of VAS score was statistically significant (P 0.05). 2. The changes of Cobb angle, the loss rate of anterior edge height of injured vertebrae, the height of intervertebral space, the score of VAS and the score of JOA were significantly different between before operation and the last follow-up (P 0.05). 3, there was no significant difference in Cobb angle, height loss rate of anterior edge of injured vertebrae and height of intervertebral space between postoperative and last follow-up (P 0.05). 4, there was significant difference in VAS score between postoperative and last follow-up (P 0.05). 5, the Frankel grading of the last follow-up nerve function was significantly improved compared with that before operation, the difference was statistically significant (Z 鈮，
本文編號：2479693
[Abstract]:Objective: to investigate the clinical effect of posterior unilateral spinal canal bone grafting in the treatment of thoracolumbar fractures after removal and internal fixation, and to provide preliminary feasible basis for clinical treatment of thoracolumbar fractures. Methods: from September 2013 to October 2014, 60 patients with thoracolumbar fractures were treated with internal fixation. According to the medical records, all patients were treated with "posterior vertebral fracture open reduction, autologous bone mixed with allogenic bone particles through unilateral vertebral canal bone grafting, spinal canal exploration and decompression, pedicle screw rod system internal fixation", respectively, before the operation, the patients were treated with posterior vertebral fracture open reduction, autologous bone mixed with allogenic bone particles through unilateral vertebral canal internal bone grafting, spinal canal exploration and decompression, and pedicle screw rod system internal fixation. After operation, the X-ray positive and lateral radiography of the injured vertebrae were taken at the last follow-up after internal fixation, and the three-dimensional reconstruction of the injured vertebrae was examined by CT plain scan. The loss rate of the anterior edge of the injured vertebrae, the height of the intervertebral space and the Cobb angle of the sagittal plane of the injured vertebrae were statistically analyzed. The scores of pain visual analog score (Visual Analogue Score,VAS) before operation, 24 hours after operation and the last follow-up were counted, and the (Japanese Orthopedics Association) JOA scores of patients before and after the last follow-up were observed. Frankel grading method was used to evaluate the recovery of neurological function before operation and at the last follow-up. Each data is processed by SPSS17.0 software. Results: all the 60 patients were followed up, 32 males and 28 females, with an average of 23.5 months. The postoperative evaluation included the loss rate of vertebral anterior edge height, the change of intervertebral space height, the sagittal Cobb angle, VAS score, JOA score and neurological function recovery. The fracture healing time was about 12 weeks, with an average of 14.5 weeks. The results of observation during hospitalization showed that the Cobb angle of sagittal plane of spine recovered from (31.22 鹵9.00) 擄before operation to (4.13 鹵1.33) 擄after operation. The ratio of height loss of anterior edge of injured vertebrae decreased from (50.23 鹵11.01)% before operation to (4.78 鹵1.97)% after operation. VAS score decreased from (6.39 鹵1.50) to (2.30 鹵0.89) and JOA score (10.33 鹵2.94). The statistical results of the last follow-up showed that the Cobb angle of the sagittal plane of the spine was (4.42 鹵1.33) 擄, the loss rate of the anterior edge of the vertebral body was (4.79 鹵1.74)%, the VAS score was (1.71 鹵0.77), and the JOA score was (21.92 鹵3.56). Among the 19 patients with neurological injury before operation, there were 3 cases of Frankel grade A, 4 cases of grade B, 2 cases of grade C, 10 cases of grade D (note: grade E was normal) to 0 cases of grade A, 2 cases of grade B and 4 cases of grade D of grade C. There was no aggravation of spinal cord nerve function damage after operation, and there was no displacement and fracture of internal fixation. 1. The changes of Cobb angle, the loss rate of anterior edge of injured vertebrae and the height of intervertebral space were compared before and after operation. The difference of VAS score was statistically significant (P 0.05). 2. The changes of Cobb angle, the loss rate of anterior edge height of injured vertebrae, the height of intervertebral space, the score of VAS and the score of JOA were significantly different between before operation and the last follow-up (P 0.05). 3, there was no significant difference in Cobb angle, height loss rate of anterior edge of injured vertebrae and height of intervertebral space between postoperative and last follow-up (P 0.05). 4, there was significant difference in VAS score between postoperative and last follow-up (P 0.05). 5, the Frankel grading of the last follow-up nerve function was significantly improved compared with that before operation, the difference was statistically significant (Z 鈮，
本文編號：2479693
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