后路椎间自体骨移植结合长段内固定治疗C型胸腰椎骨折

中华创伤杂志 Pub Date : 2019-06-15 DOI:10.3760/CMA.J.ISSN.1001-8050.2019.06.007

Zhi-jing Zhang, Yi-sheng Lu, Jian-Dong Shi, Bing Li

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These patients were scored 7-9 points [(8.0±1.1 )points] according to the thoracolumbar injury classification and severity score (TLICS) and 7-10 points [(8.5±1.4)points]according to Load sharing score (LSC). There were 20 patients with grade A and eight patients with grade B based on the American Spine Injury Association (ASIA). All patients were treated with posterior intervertebral autogenous bone grafting combined with long-segment fixation.The operation time and volume of blood loss were recorded. Kyphosis Cobb angle, visual analogue scale(VAS)and Oswestry disability index (ODI) were compared between before operation and 1 week, 3 months, 12 months and 24 months after operation.Bone grafting union was evaluated during the follow-up period by CT scan. ASIA grade was used to evaluate the functional recovery. \n \n \nResults \nAll patients were followed up for average 26 months (range, 24-36 months). 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引用次数: 0

摘要

目的探讨后路椎间自体植骨联合长节段固定治疗C型胸腰椎骨折的疗效。方法对2013年1月至2016年1月解放军903医院收治的28例C型胸腰椎骨折患者进行回顾性病例系列研究。男性20例，女性8例，年龄25 ~ 55岁，平均36.8岁。根据新的AO分类系统，所有患者均为C型骨折。损伤发生在T11-12节段5例，T12-L1节段8例，L1-2节段9例，L2-3节段6例。根据胸腰椎损伤分级及严重程度评分(TLICS)分为7 ~ 9分[(8.0±1.1)分]，根据负荷分担评分(LSC)分为7 ~ 10分[(8.5±1.4)分]。根据美国脊柱损伤协会(ASIA)评分，A级20例，B级8例。所有患者均行后路椎间自体植骨联合长节段固定。记录手术时间和出血量。比较术前与术后1周、3个月、12个月、24个月后凸角、视觉模拟评分(VAS)和Oswestry失能指数(ODI)。随访期间通过CT扫描评估植骨愈合情况。采用ASIA分级评价功能恢复情况。结果所有患者平均随访26个月(24 ~ 36个月)。手术时间(135.8±30.5)min，术中出血量(350.5±50.7)ml。术中未发生血管、神经损伤加重等严重并发症。术后无切口感染、内固定松动、骨折等严重并发症发生。术后1周、3、12、24个月局部后凸Cobb角较术前明显改善(P<0.01)。VAS和ODI在术后1周、3、12、24个月均有显著改善(P<0.01)。最后一次随访发现所有椎间骨移植物融合。末次随访时，ASIA分级结果如下:A级20例，B级3例，C级5例。结论后路椎间自体植骨联合长节段固定手术操作简单，手术时间短，创伤小，融合效果好，疼痛明显缓解，神经功能明显改善，是治疗C型胸腰椎骨折的一种手术选择。关键词:脊柱骨折;胸椎;腰椎;骨折内固定;自体移植

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Posterior intervertebral autogenous bone grafting combined with long-segment fixation for type C thoracolumbar fractures

Objective To investigate the efficacy of posterior intervertebral autogenous bone grafting combined with long-segment fixation for type C thoracolumbar fractures. Methods A retrospective case series study was performed in 28 patients with type C thoracolumbar fractures admitted to the 903 Hospital of PLA from January 2013 through January 2016.There were 20 males and eight females, aged 25-55 years, with an average of 36.8 years. All patients had type C fractures according to the new AO classification system. The injury occurred at T11-12 segment in 5 patients, T12-L1 segment in 8, L1-2 segment in 9, and L2-3 segment in 6. These patients were scored 7-9 points [(8.0±1.1 )points] according to the thoracolumbar injury classification and severity score (TLICS) and 7-10 points [(8.5±1.4)points]according to Load sharing score (LSC). There were 20 patients with grade A and eight patients with grade B based on the American Spine Injury Association (ASIA). All patients were treated with posterior intervertebral autogenous bone grafting combined with long-segment fixation.The operation time and volume of blood loss were recorded. Kyphosis Cobb angle, visual analogue scale(VAS)and Oswestry disability index (ODI) were compared between before operation and 1 week, 3 months, 12 months and 24 months after operation.Bone grafting union was evaluated during the follow-up period by CT scan. ASIA grade was used to evaluate the functional recovery. Results All patients were followed up for average 26 months (range, 24-36 months). The operation time was (135.8±30.5)minutes and the intraoperative blood loss was (350.5±50.7)ml, respectively.No serious complications occurred during the operation such as blood vessel or nerve injury aggravation.No serious complications occurred after operation such as incision infection and internal fixation loosening or fracture. Cobb angles of local kyphosis at 1 week, 3, 12 and 24 months after operation were significantly improved compared with preoperative Cobb angle (P<0.01). VAS and ODI were also significantly improved at 1 week, 3, 12 and 24 months after operation (P<0.01). The last follow-up found that all the intervertebral bone grafts were fused. At the last follow-up, ASIA grading results were as follows: grade A in 20 patients, grade B in 3 and grade C in 5. Conclusion Posterior intervertebral autogenous bone grafting combined with long-segment fixation has the advantages of simple operation, short operation time, minimal trauma, good fusion effect, significant relief of the pain and improvement of neurological function, indicating a surgical option for the treatment of type C thoracolumbar fracture. Key words: Spinal fractures; Thoracic vertebrae; Lumbar vertebrae; Fracture fixation, internal; Autologous transplant

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来源期刊

中华创伤杂志

自引率

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发文量

11327

期刊介绍： Chinese Journal of Trauma (International Standard Serial Publication Number: ISSN 1001-8050, Domestic Uniform Serial Publication Number: CN 50-1098/R) was founded in September 1985, which is the only high-level medical professional academic journal that can comprehensively and systematically reflect the achievements and development trends of China's traumatology medicine, and has a wide academic influence in China's traumatology medicine community. It has a wide range of academic influence in China's trauma medicine. Chinese Journal of Trauma is a source journal of China Science and Technology Paper Statistics, a source journal of China Science Citation Database (CSCD), a core journal of China Comprehensive Medicine and Health Care, a source journal of China Academic Journals Comprehensive Evaluation Database (CAJCED), a full-text journal of China Journal Full-text Database (CJFD), a core academic journal of China Center for Scientific Evaluation (RCCSE), a core academic journal of China Traumatology and Traumatology Center (CTC), a core academic journal of China Traumatology Center (RCCSE). RCCSE) core academic journals; Chinese Biomedical Journal Database (CMCC), Chinese Biomedical Journal Citation Database (CBJCED), China Journal Network (CJN), China Academic Journals (CD-ROM), Chinese Academic Journals Abstracts (Chinese Edition), Chemical Abstracts of the United States (CA), Index Copernicus of Poland (IC), and Japan Institute of Science and Technology Database (JICST), World Health Organization Western Pacific Region Medical Search (WPRIM) and Russian Journal of Abstracts (ΡЖ) included journals.