高峰　张智达　孙成群

[摘要] 目的 研究不同融合方式對胸腰椎爆裂性骨折后路手术临床疗效的影响。 方法 选择2012年2月～2016年2月间本院胸腰椎爆裂性骨折采用后路内固定手术的病例共89例，运用随机数表法，将其分为研究组41例和对照组48例。研究组采取椎体加椎间植骨融合，对照组进行后外侧植骨融合，记录两组患者手术时植骨容量，记录其手术前、手术后以及术后1年时伤椎Cobb角的数值，评估术后1年时矫正度丢失情况，对两组患者1年后骨性融合情况进行对比。 结果 研究组术后即刻伤椎Cobb角度数小于对照组患者，并且1年后随访发现研究组患者的伤椎Cobb角度数以及矫正度丢失情况同时小于对照组，差异有统计学意义（P<0.05）。研究组患者于术后1年进行随访发现，其骨性融合率为97.56%，明显高于对照组（81.25%），差异具有统计学意义（P<0.05）。结论 胸腰椎爆裂性骨折患者行后路手术中实施椎体加椎间植骨融合效果优于实施后外侧植骨融合，患者骨融合程度好，矫正程度丢失少，有利于后期恢复，值得推广。

[关键词] 椎体加椎间植骨融合；外侧植骨融合；胸腰椎爆裂性骨折；手术治疗

[中图分类号] R687.3 [文献标识码] B [文章编号] 1673-9701（2018）20-0095-04

Effect of different fusion methods on the curative effect of thoracolumbar burst fractures treated with posterior internal fixation

GAO Feng ZHANG Zhida SUN Chengqun REN Yingqing TAO Bo

Department of Spine Surgery， Yuyao People's Hospital in Zhejiang Province， Yuyao 315400， China

[Abstract] Objective To compare the effects of different fusion methods on the clinical efficacy of posterior thoracolumbar burst fractures treated with posterior internal fixation. Methods A total of 89 cases of thoracolumbar burst fractures in our hospital from February 2012 to February 2016 were treated with posterior internal fixation. A total of 89 cases were divided into study group（n=41） and control group（n=48） using random number table method. In the study group， vertebral body plus interbody fusion was used. In the control group， the posterolateral fusion was performed. The bone graft capacity of the two groups was recorded. The Cobb angle before and after operation and 1 year after operation were recorded， assessed the loss of orthodontic correction at 1 year after surgery and compared the bony fusion after 1 year in both groups. Results The Cobb angle of injured vertebrae immediately after operation in study group was smaller than that in control group. Cobb angle and loss of correction of injured vertebrae in study group were less than those in control group at one year follow-up. The difference was statistically significant（P<0.05）. The patients in the study group were followed up for one year after operation. The bony fusion rate was 97.56% in the study group， which was significantly higher than that in the control group（81.25%）. The difference was statistically significant（P<0.05）. Conclusion In patients with thoracolumbar burst fractures， the effect of vertebral body plus interbody fusion after posterior approach is better than that of posterolateral fusion. The degree of bone fusion is good and the degree of orthodontic loss is less， which is good for the later recovery and is worth popularizing.

[Key words] Vertebral body plus interbody fusion； Lateral bone fusion； Thoracolumbar burst fractures； Surgical treatment

随着现代社会的高速发展，脊柱骨折的发生率出现逐渐增高的趋势，而胸腰椎骨折为脊柱骨折中常见的类型[1]。胸腰椎爆裂性骨折一般指位于T11-L2节段的脊柱骨折，并且椎体前、中柱均有累及。此类患者常因椎管内占位引起脊髓、硬膜及神经根的损伤，高达90%以上的患者需要接受手术治疗[2]。临床表明，治疗胸腰椎爆裂性骨折患者的方法中经前路手术治疗与经后路手术治疗均较为常见，但众所周知的是，胸腰椎骨折前路手术相对于后路手术而言，手术创伤较大，而单纯经后路手术治疗很难解决前柱重建稳定、椎管减压等难题，同时手术时间长，风险增大，后路手术时进行骨融合逐渐被广泛应用[3]。……