经后路椎间植骨在腰椎爆裂骨折中应用.docVIP

经后路椎间植骨在腰椎爆裂骨折中应用摘 要 目的：观察经后路椎间植骨与单纯后外侧植骨融合治疗腰椎爆裂骨折，对比两种不同植骨融合方式的近远期效果。方法：收治的腰椎爆裂骨折患者24例，平均年龄31?2岁，神经功能按Frankel分级，A级2例，B级4例，C级7例，D级8例，E级3例。根据CT判断椎管内占位程度及马尾、神经根受压情况和有无神经症状分为两组，A组13例，CT示椎管内占位程度重，马尾、神经根受压，有明显神经症状，采用经后路骨折复位椎管减压及椎间、后外侧植骨融合术；B组11例，CT示椎管内占位程度相对较轻，未超过50%，马尾、神经根无明显受压，仅有神经根激惹症状或无神经症状，采用单纯后外侧植骨，以上患者均结合椎弓根螺钉固定。结果：术后伤口均Ⅰ期愈合，神经损伤症状无加重。24例获得9～28个月，平均18.8个月随访。4～6个月植骨融合，无椎弓根螺钉松动、断裂，无椎间植骨脱落至椎管内，除2例完全性截瘫患者及3例无神经损害症状患者神经功能无变化外，其余病例神经功能均有明显恢复，两种手术方式Frankel分级分别平均恢复1.6与0.6级。取得较满意疗效。结论：椎间和后外侧植骨融合率与单纯后外侧植骨融合率、融合时间及术中平均输血量、神经功能恢复均有显著差异(P＜0.05)，A组植骨所需量多于B组。 关键词 后路 椎间植骨 后外侧植骨 腰椎骨折 Abstract Objective:observe the vertebral bone graft posterior between with simple bone graft posterolateral lumbar fusion treatment burst fracture,the contrast between two different ways of cancellous bone fusion JinYuanQi effect.Methods:retrospective analysis in September 2004 to March 2009,at an average age of 31.2 years were the lumbar burst fracture 24 cases,nerve function classification by Frankel,A level 2 cases,grade B 4 cases,grade C in 7 cases,D level 8 cases,E level 3 cases.According to the CT judgment the spinal canal sites degree and the horsetail,nerve root compression condition and have neurological symptoms divided into two groups,A group of 13 cases,CT demonstrating the spinal canal sites degree heavy,horsetail,nerve root compression,there are obvious symptoms,by the posterior fracture restoration vertebra canal decompression and between vertebra,posterolateral interbody fusion;Group B 11 cases,CT demonstrating the spinal canal degree the placeholder relatively light,not more than 50%,horsetail,nerve root no obvious under pressure,only the nerve root symptoms or signs of without neurological symptoms,use simple outside after bone graft,more people are combined with pedicle screws.Results:after operation,the wound are primary healing,nerve damage symptoms worse.24 cases get 9～28 months,an average of 18.8 months follow-up.4～6 month cancellous bone fusion,no pedicle screws loose,fr