经后路椎体次全切除术联合椎间支撑植骨治疗胸腰椎爆裂性骨折的疗效分析
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摘要
目的探究经后路椎体次全切除术联合椎间支撑植骨治疗胸腰椎爆裂性骨折的临床疗效。方法回顾性分析2015年1月—2017年1月第九八医院骨科收治的胸腰段椎体爆裂骨折患者60例,其中男性35例,女性25例;年龄25～51岁,平均37.4岁。根据手术方式分为植骨术组和联合组各30例。植骨术组实施经后路椎体次全切除联合椎间支撑植骨术,联合组实施前后路联合手术。比较两组平均手术时间、平均术中出血量、平均住院时间和术后愈合时间、术后并发症情况、术后不同时间点VAS评分、健康状况调查简表(SF-36)评分、Cobb角和椎体高度压缩率。结果术后所有患者获得随访,随访方式为电话随访或来院随访,时间12～28个月,平均17.3个月。植骨术组平均手术时间[(139.3±37.2)min vs.(182.5±42.6)min]、平均术中出血量[(216.5±57.2)mL vs.(327.9±75.8)mL]、术后平均住院时间[(7.5±1.4)d vs.(9.3±2.0)d]和平均骨折愈合时间[(6.2±0.9)个月vs.(7.4±1.1)个月]均小于联合组(P<0.05)。术后部分患者出现切口感染、切口疝、脑脊液漏、植骨块移位和内固定失效,经对症处理或二次手术后均好转,植骨术组术后并发症总发生率高于联合组(P<0.05)。术后3、6个月时两组VAS评分、SF-36评分、Cobb角和椎体高度压缩率差异均无统计学意义(P>0.05)。结论严重胸腰椎爆裂性骨折,经后路椎体次全切除术联合椎间支撑植骨疗效与前后路联合手术相当,手术创伤更小,值得推广。
Objective To explore the curative efficacy of posterior corpectomy combined with intervertebral bone graft in the treatment of thoracolumbar burst fracture. Methods From Jan. 2015 to Jan. 2017,60 patients(35 males and 25 females aged of 37.4(25-51) years) with thoracolumbar vertebral burst fracture were selected and divided into observation group(n=30) and control group(n=30) according to different surgical methods. The observation group underwent posterior subtotal vertebral resection combined with interbody support and bone grafting,while the control group underwent anterior and posterior combined surgery. The clinical data such as mean operation time,mean intraoperative blood loss,mean hospital stay,postoperative healing time,postoperative complications,postoperative VAS score at different time points,postoperative health status survey(SF 36) score,Cobb angle and vertebral height compression rate were compared between two groups. Results All patients were followed up by telephone or in-hospital for 12 to 28 months,with an average follow-up time of 17.3 months.The average operation time,bleeding volume,hospital stay and fracture healing time of the observation group were less than those of the control group((139.3±37.2)min vs.(182.5±42.6)mi,(216.5±57.2)mL vs.(327.9±75.8)mL,(7.5±1.4)d vs.(9.3±2.0)d,(6.2±0.9)months vs.(7.4±1.1)months,P<0.05).Postoperative infection,incisional hernia,cerebrospinal fluid leakage,bone graft displacement and internal fixation failure occurred in some patients,which were improved after symptomatic treatment or second operations. The total incidence of complications in the bone grafting group was higher than that in the combined group(P<0.05). There was no significant difference in VAS score,SF-36 score,Cobb angle and vertebral height compression rate between the two groups at 3 and 6 months after operation(P>0.05). Conclusion For severe thoracolumbar burst fractures,posterior subtotal vertebrectomy combined with interbody support and bone grafting is as effective as anterior and posterior combined surgery,with less surgical trauma.
Objective To explore the curative efficacy of posterior corpectomy combined with intervertebral bone graft in the treatment of thoracolumbar burst fracture. Methods From Jan. 2015 to Jan. 2017,60 patients(35 males and 25 females aged of 37.4(25-51) years) with thoracolumbar vertebral burst fracture were selected and divided into observation group(n=30) and control group(n=30) according to different surgical methods. The observation group underwent posterior subtotal vertebral resection combined with interbody support and bone grafting,while the control group underwent anterior and posterior combined surgery. The clinical data such as mean operation time,mean intraoperative blood loss,mean hospital stay,postoperative healing time,postoperative complications,postoperative VAS score at different time points,postoperative health status survey(SF 36) score,Cobb angle and vertebral height compression rate were compared between two groups. Results All patients were followed up by telephone or in-hospital for 12 to 28 months,with an average follow-up time of 17.3 months.The average operation time,bleeding volume,hospital stay and fracture healing time of the observation group were less than those of the control group((139.3±37.2)min vs.(182.5±42.6)mi,(216.5±57.2)mL vs.(327.9±75.8)mL,(7.5±1.4)d vs.(9.3±2.0)d,(6.2±0.9)months vs.(7.4±1.1)months,P<0.05).Postoperative infection,incisional hernia,cerebrospinal fluid leakage,bone graft displacement and internal fixation failure occurred in some patients,which were improved after symptomatic treatment or second operations. The total incidence of complications in the bone grafting group was higher than that in the combined group(P<0.05). There was no significant difference in VAS score,SF-36 score,Cobb angle and vertebral height compression rate between the two groups at 3 and 6 months after operation(P>0.05). Conclusion For severe thoracolumbar burst fractures,posterior subtotal vertebrectomy combined with interbody support and bone grafting is as effective as anterior and posterior combined surgery,with less surgical trauma.
引文
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[10] 廖国平,邓芳文,孙德贵,等.前入路与后入路手术比较治疗胸腰椎爆裂性骨折的Meta分析[J].临床医药实践,2015,24(10):725-731.
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[12] 吴晓鸿,李建栋,第五勇刚.一期后路伤椎次全切除三柱重建治疗严重胸腰椎骨折[J].临床骨科杂志,2018,21(3):274-277.
[13] 高博,幸嵘,孔清泉,等.经后路椎体次全切除加椎间支撑植骨治疗胸腰椎爆裂性骨折及骨折脱位的早期疗效观察[J].中国修复重建外科杂志,2012,26(5):542-545.
[14] Chang KW,Leng X,Zhao W,et al.Quality control of reconstructed sagittal balance for sagittal imbalance[J].Spine,2011,36(3):E186-197.
[15] 何斌,吴永铁,杨波,等.后路椎体次全切除稳定性重建治疗不稳定胸腰椎爆裂骨折的并发症及处理措施[J].中国脊柱脊髓杂志,2015,25(5):415-419.
[2] 王梁谦,蔡南川,刘大军,等.经后路椎体次全切除加椎间支撑骨治疗早期胸腰椎爆裂性骨折的疗效观察[J].重庆医学,2014,43(30):4085-4087.
[3] 何明长,林斌,许洋,等.后路椎体次全切除治疗胸腰椎爆裂性骨折[J].临床骨科杂志,2015,18(2):133-135,140.
[4] 张振武,饶小华,田纪青.一期前后联合入路手术治疗严重胸腰段及腰椎骨折[J].中国脊柱脊髓杂志,2010,20(3):228-234.
[5] 庄全魁,陈勇,李杨,等.后路椎体次全切除椎间支撑植骨治疗胸腰椎爆裂骨折疗效观察[J].蚌埠医学院学报,2014,39(9):1223-1225.
[6] Park SJ,Lee CS,Chung SS,et al.Postoperative changes in pelvic parameters and sagittal balance in adult isthmic spondylolisthesis[J].Neurosurgery,2011,68(S2):355-363.
[7] 沈皆亮,郝杰,胡侦明,等.后路椎体次全切钛网植入内固定治疗胸腰椎爆裂骨折[J].创伤外科杂志,2015,17(5):430-433.
[8] 张伟,李程,陈国斌,等.经椎弓根植骨治疗胸腰椎爆裂骨折手术技巧及风险防范[J].临床骨科杂志,2015,18(3):299-302.
[9] 苏新磊,张桂莲,杨忠奎,等.伤椎椎体内植骨结合后外侧植骨内固定治疗胸腰椎爆裂骨折的疗效[J].临床骨科杂志,2016,19(4):419-422.
[10] 廖国平,邓芳文,孙德贵,等.前入路与后入路手术比较治疗胸腰椎爆裂性骨折的Meta分析[J].临床医药实践,2015,24(10):725-731.
[11] Labelle H,Mac-Thiong JM,Roussouly P.Spino-pelvic sagittal balance of spondylolisthesis: a review and classification[J].Eur Spine J,2011,20(S5):S641-646.
[12] 吴晓鸿,李建栋,第五勇刚.一期后路伤椎次全切除三柱重建治疗严重胸腰椎骨折[J].临床骨科杂志,2018,21(3):274-277.
[13] 高博,幸嵘,孔清泉,等.经后路椎体次全切除加椎间支撑植骨治疗胸腰椎爆裂性骨折及骨折脱位的早期疗效观察[J].中国修复重建外科杂志,2012,26(5):542-545.
[14] Chang KW,Leng X,Zhao W,et al.Quality control of reconstructed sagittal balance for sagittal imbalance[J].Spine,2011,36(3):E186-197.
[15] 何斌,吴永铁,杨波,等.后路椎体次全切除稳定性重建治疗不稳定胸腰椎爆裂骨折的并发症及处理措施[J].中国脊柱脊髓杂志,2015,25(5):415-419.