| ObjectiveThe rapid development of modern transportation, industrial, mining andconstruction industry, the incidence rate of accidents are on the rise. The fracture ofthoracic and lumbar spine the surgical operation reset can make the vertebraleffectively restore the anatomy of the original, restore the spinal physiologicalcurvature and lateral stability increased. However, despite the X-ray examination ofintraoperative and postoperative confirmed vertebral front height recovered,framework of vertebral body to recover. But most of the vertebral body chancellor’sbone after trauma after compression orbicular bone can not completely reset theexistence of a large cavity after surgical reduction of the vertebral body, theemergence of bone defect area, the formation of "shell" effect. The cavity byhecatomb, fibrous connective tissue filled does not make the fracture healedcompletely. Thus causing postoperative vertebral stiffness decreased two timescompression vertebral, spinal motion stability and further damage to units, andproduces a series of clinical symptoms. Therefore, to the cavity vertebral reset afterbecome effective means of bone grafting in the reduction of two compression of thevertebral body. Evidence based medical research confirmed that autonomous bonegraft is the gold standard for vertebral compression fracture of vertebral body bonegraft. But the autogenously bone grafting has some defects, such as: the need to dobone surgery in other parts of the body to increase patients, patients with surgicaltrauma, bone area of the existence of incision infection, chronic pain, nerve injury,vascular injury, the risk of bone fracture. This research through the observation of the autonomous iliac bone graft and hydroxyapatite artificial bone graft in the treatmentof thoracolumbar vertebral compression fractures of bone graft treatment, clinicalcurative effect is the same,hydroxyapatite artificial bone can be used as a substitutefor autogenously bone is the.MethodsSource of case This study observed the open reduction and pedicle screw rodsystem fixation and transpedicular bone grafting were a total of66cases of FAWgeneral hospital in2009March--2011year in March the Department of orthopedicsduring a single segment of thoracolumbar vertebral compression fracture for fracture.Patients, male45cases, female21cases, age24-71years old.10thoracic fractures in6cases, thoracic11fractures in10cases, thoracic12fractures in17cases, lumbar1fractures in20cases, lumbar2fractures in13cases. The patient group According tothe different vertebral implant into two groups: autonomous iliac bone graft(autonomous bone group)29cases, hydroxyapatite artificial bone (hydroxyapatite,HA) bone graft (artificial bone group)37cases.All the patients underwent posterior thoracolumbar open reduction and pediclescrew rod system fixation and transpedicular vertebral body filling to implantautonomous iliac bone particles or hydroxyapatite artificial bone particles.Intraoperative fracture reduction standard:： Intraoperative C arm X light sideperspective display vertebral disease on inferior endplate of parallel lines, before andafter the disease vertebral edge height is less than2mm. Bone standard：Applicationof layered impaction bone grafting technique in the C arm X ray showed vertebralbody bone graft particles arranged closely, and any adjacent bone graft particlessmaller than the gap between bone particle radius. Respectively at6months after theoperation, after3years of follow-up2, spinal surgeons to patients with specialistexamination, was shot lateral DR piece, measuring the height of vertebral body. Fill inthe subjective and objective score table of project. Processing data was recorded usingExcel2003software data double entry method. Measurement data were compared with t test, count data were compared with thechi square test; do not obey the normal distribution of the data using a non parametrictest. With P <0.05, is statistical significance.ResultsTwo groups of patients immediately after operation and6months after surgery,3years after surgery and lateral DR tablets, the measured height of vertebral body andpreoperative vertebral height for comparison: immediately after operation and6months after operation, postoperative vertebral height was3years compared with thepreoperative recovery (P<0.05).Two groups were compared respectively between group, preoperative vertebralheight, immediately after operation and6months after surgery, after3years ofvertebral height comparison, statistical tests showed no significant difference(P>0.05).Were patients of two groups after6months, after3years of vertebralcompression again value comparison, two follow-up was measured again thecompressed values between two groups were not statistically significant (P>0.05)Patients in the two groups were6months after surgery, postoperative follow-upof3years and ODI score. The excellent and good rate was statistically significantbetween the two groups in total score of ODI analysis showed that two groups ofpatients at6months postoperatively, no significant difference between the ODI scorethe excellent and good rate3year after surgery (P>0.05).The patients of two groups after6months, after3years of follow-up between thegroups of ODI each item score and total score comparison. In the back of the level ofpain, activity of daily living, walking, standing, sleep, sex, social activities and totalscores had no significant difference (P<0.05);There are differences and autogenously bone is better than that of the artificialbone in the extract, sit, travel and other three projects (P>0.05).Using the lumbar JOA released after fracture operation objective index scoretable for patients in the two groups were6months after surgery and postoperative3 years score. After6months and3years after surgery two times follow-up of objectiveindex score was compared between two groups, no significant difference (P>0.05).After the operation the objective index score table for two groups of patients withobjective indicators score were compared by lumbar fracture published by JOA.In6months after operation and postoperative two times3years scoring, spinoutsprocess tenderness, spinal mobility, hypnosis angle measurement, then thecompression ratio and the total objective score no significant difference (P>0.05);there are differences and autogenously bone is better than that of the artificial bone inthe fracture healing degree (P<0.05).Conclusion1. hydroxyapatite artificial bone in the vertebral body bone graft surgery in termsof adaptability and operability, filling effect with autogenously bone is quite;2. hydroxyapatite artificial bone graft in the comprehensive evaluation ofsubjective items on the same patients with autonomous bone; but in the bear the axialload on the inferior to the autogenously bone group;3. hydroxyapatite artificial bone graft in the comprehensive evaluation of patientswith the same objective indicators observed with autonomous bone. The degree offracture healing is inferior to auto graft group, mechanical properties but thisdifference was not enough to affect the artificial bone graft;4. in the autonomous bone more satisfactory substitute research, vertebral bearaxial load capacity and the degree of fracture healing need to further strengthen;5. through comprehensive evaluation, hydroxyapatite artificial bone withautonomous bone fracture in the thoracolumbar vertebral body bone graft clinicalcurative effect of the same, as a substitute for autogenously bone is widely used in thesimilar treatment of hydroxyapatite artificial bone can be. |
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