经伤椎椎弓根螺钉固定联合经伤椎椎弓根植骨治疗胸腰椎骨折的效果[摘要]目的探?经伤椎椎弓根钉固定联合经伤椎椎弓根椎体内植骨治疗胸腰椎骨折的效果。方法回顾性分析我院2011年9月～2015年8月收治的109例胸腰椎骨折患者，根据治疗方法的不同分为A组（49例）和B组（60例）。A组采用单纯经伤椎椎弓根钉固定，B组采用经伤椎椎弓根钉固定联合经伤椎椎弓根椎体内植骨。术后随访8～29个月，平均随访15.1个月。比较两组术前、术后及末次随访数字射线摄影（DR）侧位片上测量的伤椎前缘高度压缩比、伤椎相邻椎Cobb角，记录两组的手术时间、手术出血量及手术并发症。结果B组的手术时间长于A组，出血量多于A组，差异有统计学意义（P<0.05）。两组术后及末次随访的伤椎前缘高度压缩比大于术前，Cobb角小于术前，差异有统计学意义（P<0.05）。A组末次随访的伤椎前缘高度压缩比小于术后，Cobb角大于术后，差异有统计学意义（P<0.05）。B组末次随访的伤椎前缘高度压缩比、Cobb角与术后比较，差异无统计学意义（P>0.05）。两组术前、术后的伤椎前缘高度压缩比、Cobb角比较，差异无统计学意义（P>0.05）。B组末次随访的伤椎前缘高度压缩比大于A组，Cobb角小于A组，差异有统计学意义（P<0.05）。A组有1例断钉，1例螺钉松动椎体高度后凸角度丢失，出现神经压迫症状需再次手术；B组无螺钉松动、无断钉。结论在胸腰椎骨折经伤椎椎弓根钉固定联合经伤椎椎弓根椎体内植骨治疗术中，经伤椎置钉可较好地恢复椎体高度，纠正后凸畸形角度；同时联合经伤椎弓根椎体内植骨，可减少远期螺钉松动、断钉及椎体高度、Cobb角丢失等并发症。[关键词]胸腰椎骨折；伤椎；固定；椎弓根钉；植骨[]R683.2[文献标识码]A[]1674-4721（2017）10（a）-0107-04[Abstract]ObjectiveToexploretheclinicalefficacyofpediclescrewfixationcombinedwithtranspedicularbonegraftinginthetreatmentofthoracolumbarfractures.MethodsClinicaldataof109caseswiththoracolumbarfracturefromSeptember2011toAugust2015inourhospitalwereretrospectivelyanalyzed，allpatientsweredividedintogroupA（49cases）andgroupB（60cases）accordingtodifferenttreatmentmethods.GroupAwastreatedwithsimplepediclescrewfixation，andgroupBwastreatedwiththepediclescrewfixationofthefracturedvertebracombinedwithtranspedicularbonegraftingoftheinjuredvertebra.Allpatientswerefollowedupfor8-29months，themeanfollow-upwas15.1months.Thecompressionratiooftheleadingedgeheightoftheinjuredvertebra，theadjacentvertebralCobbangleindigitalradiography（DR）preoperative，postoperativeandfinalfollow-upinthetwogroupswerecompared.Operationtime，bloodlossandcomplicationsinthetwogroupswererecorded.ResultsTheoperationtimeofgroupBwaslongerthanthatofgroupA，andtheamountofbleedingofgroupBwasmorethanthatofgroupA，withsignificantdifference（P<0.05）.Thecompressionratiooftheleadingedgeheightoftheinjuredvertebraafteroperationandfinalfollow-upofthetwogroupswasgreaterthanthatbeforeoperation，andtheangleofCobbafteroperationandfinalfollow-upofthetwogroupswassmallerthanthatbeforeoperation，withsignificantdifference（P<0.05）.Thecompressionratiooftheleadingedgeheightoftheinjuredvertebrafinalfollow-upofgroupAwassmallerthanthatafteroperation，andtheangleofCobbfinalfollow-upofgroupAwasgreaterthanthatafteroperation，withsignificantdifference（P<0.05）.TherewasnosignificantdifferenceinthecompressionratiooftheleadingedgeheightoftheinjuredvertebraandtheangleofCobbofgroupBbetweenfinalfollow-upandafteroperation（P>0.05）.TherewasnosignificantdifferenceinthecompressionratiooftheleadingedgeheightoftheinjuredvertebraandtheangleofCobbbeforeoperationandafteroperationbetweenthetwogroups（P>0.05）.Thecompressionratiooftheleadingedgeheightoftheinjuredvertebrafin...