目的：探讨胸腰椎骨折复位术后椎体发生骨不连现象的相关危险因素。

方法：回顾性分析2016年01月-2019年03月我院行后入路短节段椎弓根钉棒系统复位内固定术治疗的胸腰椎单节段骨折且骨量正常患者119例，术后随访12-19个月，术后1年完善CT检查。最终将具有完整术前及术后随诊影像学资料的患者共74例纳入样本量。通过术后1年时伤椎水平位或矢状位CT图像观察椎体骨不连现象的发生情况，分别记录患者的年龄、性别、BMI指数、术前椎体压缩程度、术前矢状面Cobb角、术前椎间盘完整性、伤椎置钉情况、术后骨折撑开复位情况等相关因素，通过单因素分析和多因素Logistic回归分析研究各因素与术后椎体发生骨不连现象的相互关系，最后通过ROC曲线验证各因素与术后椎体不连现象相关性的预测关系。

结果：74例患者中有40例患者术后发现椎体骨不连现象，发生率为54.05％；35例患者无临床症状。单因素分析表明患者术前的椎间盘完整性、椎体压缩程度以及术后骨折的撑开复位情况、伤椎置钉情况与椎体骨不连现象的发生密切相关（P<0.05），而患者的BMI指数、性别、年龄及术前矢状面Cobb角与椎体骨不连的发生无相关性（P>0．05）。多因素分析显示患者的骨折撑开复位情况、术前椎体压缩程度、术前椎间盘完整性是影响术后椎体骨不连现象发生的独立危险因素，其ROC曲线下面积分别为：0.660，0.706，0.646（P＜0.05）。

结论：术前椎间盘完整性，术前椎体压缩程度、骨折撑开复位情况是单节段骨量正常胸腰椎骨折患者术后出现椎体骨不连现象的独立危险因素。

Aim: To explore the related risk factors of vertebral body nonunion after thoracolumbar fracture reduction.

Methods: A retrospective analysis of 119 patients with thoracolumbar vertebral single-segment fractures treated with posterior short-segment pedicle screw rod reduction and internal fixation from January 2016 to March 2019 in our hospital, followed up for 12-19 months The CT examination was perfected 1 year after operation. A total of 74 patients with complete preoperative and postoperative follow-up imaging data were finally included in the sample size. The incidence of vertebral bone nonunion was observed by CT images of injured vertebral horizontal or sagittal at 1 year after operation. The age, gender, BMI index, preoperative vertebral compression degree, and sagittal plane before operation were recorded. Cobb angle, intervertebral disc integrity before surgery, vertebral nailing after trauma, postoperative fracture reduction and reduction, and other related factors. Univariate analysis and multivariate logistic regression analysis were used to study the relationship between each factor and the occurrence of nonunion in the vertebral body after surgery. The correlation was finally verified by the ROC curve.

Results: The vertebral bone nonunion was found in 40 of 74 patients after surgery, with an incidence of 54.05%; 35 patients had no clinical symptoms. Univariate analysis showed that the integrity of the intervertebral disc, the degree of compression of the vertebral body, the expansion and reduction of fractures, and the placement of injured vertebral nails were closely related to the occurrence of vertebral bone nonunion (P <0.05). There was no correlation between the BMI index, gender, age, and preoperative sagittal Cobb angle and the occurrence of vertebral bone nonunion (P> 0.05). Multivariate analysis showed that the patient's fracture expansion and reduction, the degree of vertebral compression before operation, and the integrity of the intervertebral disc before operation were independent risk factors that affected the occurrence of nonunion of the vertebral body after surgery. The areas under the ROC curve were: 0.660, 0.706, 0.646 (P <0.05).

Conclusion: Preoperative disc integrity, preoperative vertebral compression, and fracture reduction were caused by posterior short-segment pedicle screw system reduction and internal fixation for vertebral bone nonunion after thoracolumbar fracture Independent risk factors.

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[3] 安毅, 李晶, 刘兰泽,等. 胸腰椎骨折经椎弓根椎体内植骨术后伤椎愈合情况的对比[J]. 中国骨与关节损伤杂志, 2015, 30(5):460-463.

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