不同植骨融合方式对胸腰椎爆裂性骨折疗效的影响

不同植骨融合方式对胸腰椎爆裂性骨折疗效的影响

罗一邓展生陈静

【摘 要】目的评价不同植骨融合方式治疗胸腰椎爆裂性骨折的临床疗效，探讨最佳的植骨融合方式。 方法 2000年6月－2009年6月，采用一期后路短节段内固定植骨融合治疗126例胸腰椎爆裂性骨折患者。均为急性脊柱脊髓损伤，损伤节段T11～L2；均合并不同程度脊髓神经功能损伤，Frankel分级在D级以下。将患者随机分成A、B、C 3组，分别辅以椎体加椎间植骨（A组）、后外侧植骨（B组）及360°环形植骨（C组）3种植骨融合方式进行治疗，观察各组患者术后伤椎Cobb角以及矫正度丢失、骨性融合率、内固定失效率、Oswestry功能障碍指数（ODI）及Frankel分级情况等的变化，评价不同植骨融合方式的疗效。 结果 126例患者均获随访，随访时间24～32个月，平均28个月。C组手术时间和术中出血量均多于A、B组（P < 0.05），A、B组间差异无统计学意义（P > 0.05）。术后2年及末次随访时B组Cobb角及矫正丢失度均显著大于A、C组，比较差异有统计学意义（P < 0.05），A、C组间差异无统计学意义（P > 0.05）。末次随访时A组骨性融合率及内固定失效率分别为100%、0，B组分别为78.6%、21.4%，C组分别为97.5%、0，B组与A、C组比较差异均有统计学意义（P < 0.05），A、C组间比较差异无统计学意义（P > 0.05）。术后各组ODI及Frankel分级均较术前有明显改善（P < 0.05），末次随访时B组与A、C组比较差异有统计学意义（P < 0.05），A、C组间比较差异无统计学意义（P > 0.05）。 结论椎体加椎间植骨融合符合人体生物力学特点，能获得最佳的节段性骨性融合，是一种较优的骨性融合方式；后外侧植骨不符合人体生物力学特点，内固定失效率高，不是一种适宜的植骨融合方式；360°环形植骨并未表现出最佳的骨性融合率，而且性价比低，可能并不是一种必需的植骨融合方式。

【关键词】胸腰椎爆裂性骨折椎体加椎间植骨融合后外侧植骨融合环形植骨融合

EFFECTIVENESS OF DIFFERENT BONE GRAFT FUSION WAYS IN TREATING THORACOLUMBAR BURST FRACTURES/LUO Yi, DENG Zhansheng, CHEN Jing. Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha Hunan, 410008, P.R.China. Corresponding author: DENG Zhansheng, E-mail: dzsspine@ 【Abstract】Objective To assess the effectivness of different bone graft fusion ways in the treatment of thoracolumbar burst fractures. Methods Between June 2000 and June 2009, 126 cases of thoracolumbar burst fractures were treated by one-stage posterior short segment internal fi xation combined with bone graft fusion. All patients had acute spine and spinal injury at the levels of T11-L2, who were with different degrees of neural function injury (below Frankel grade D). The patients were randomly divided into 3 groups and were treated respectively by centrum combined with interbody bone graft fusion (group A), posterolateral bone graft fusion (group B), and ring bone graft fusion (group C) combined with posterior short segment pedicle instrumentation. The changes of the Cobb angle, correction loss of Cobb angle, bone fusion rate, internal fi xation failure rate, Oswestry Disability Index (ODI), and Frankel grade of the fracture vertebral were observed after operation to evaluate the effectiveness of different bone graft fusion ways. Results All 126 cases were followed up 24-32 months (mean, 28 months). The operation time and bleeding volume in group C were signifi cantly larger than those in groups A and B (P < 0.05), but no signifi cant difference was found between groups A and B (P > 0.05). At 2 years after operation and last follow-up, the Cobb angle and correction loss in group B were signifi cantly larger than those in groups A and C (P < 0.05), but there was no signifi cant difference between groups A and C (P > 0.05). At last follow-up, the bone fusion rate and internal fi xation failure rate were 100% and 0 in group A, 78.6% and 21.4% in group B, and 97.5% and 0 in group C; there were signifi cant differences between group B and groups A, C (P < 0.05), but no signifi cant difference was found between groups A and C (P > 0.05). ODI and Frankel grade were obviously improved after operation, showing signifi cant differences between preoperation and last follow-up (P < 0.05) in 3 groups, between group B and groups A, C (P < 0.05), but no signifi cant difference was found between groups A and C (P > 0.05). Conclusion The centrum combined with interbody bone graft fusion is best in 3 bone graft fusion ways because of its optimum bone fusion and according with human body biomechanics mechanism. Back outboard bone graft fusion may not a appropriate bone fusion way because of its high internal fi xation failure rate and not according with human body biomechanics mechanism. The ring bone graft fusion may not be an indispensable bone fusion way because of its common bone fusion ratio and lower cost-performance ratio.

作者单位：中南大学湘雅医院脊柱外科（长沙，410008）

通讯作者：邓展生，教授，博士生导师，研究方向：脊柱脊髓损伤与修复重建，E-mail: dzsspine@

网络出版时间：2011-10-12 14:10:21；网络出版地址：/kcms/detail/51.1372.R.20111012.1410.201111.22_006.html