经伤椎与跨伤椎固定对椎体形态影响的临床观察

目的:比较经伤椎与跨伤椎固定技术治疗胸腰椎骨折对椎体形态的远期影响。方法:回顾性分析2008年1月至2010年12月收治的48例单一椎体胸、腰椎骨折患者的临床资料,其中采用跨伤椎固定(A组)36例,男28例,女8例;年龄21～60岁,平均(43.5±8.6)岁;经伤椎固定(B组)12例,男8例,女4例;年龄24～57岁,平均(42.0±7.4)岁。随访时间6～24个月,平均11.5个月。在手术前、手术后1周及随访结束时,分别对两组病例的椎体高度、终板夹角、神经功能进行比较。结果:在手术前A、B两组间椎体高度、终板夹角及神经功能分级差异无统计学意义(P>0.05),在手术后1周及随访结束时,两组在椎体高度、终板夹角均较术前明显改善(P<0.05),且B组椎体高度、终板夹角明显优于A组(P<0.05);两组间在神经功能方面的差异无统计学意义(P>0.05)。结论:经伤椎固定技术治疗胸腰椎骨折,与跨伤椎固定相比,具有复位效果好,固定牢靠,远期椎体形态好的优点。

Clinical observation on influence of vertebral fixation through or across the affected vertebra on vertebral morphology

Objective:To compare the long-term influence of vertebral fixation through or across the affected vertebra on vertebral morphology. Methods:Clinical data of 48 patients with simple thoracic and lumbar spinal fractures who were admitted between Jan. 2008 and Dec. 2010 were analyzed retrospectively. Among them 36 cases (28 males and 8 females) were fixed through the injured vertebra (group A) and 12 cases (8 males and 4 females) were fixed across the injured vertebra (group B). All patients were followed up for 6-36 months (mean 11.5 months). The vertebral body height,endplate angle and neurofunction were compared between the two groups before surgery,a week after surgery and at the end of the follow-up period. Results:There was no statistically significant difference in vertebral body height,endplate angle and neurofunction before operation between group A and B(P>0.05). Vertebral body height and endplate angle improved in both groups a week after operation and at the end of the follow-up period as compared with those before operation (P<0.05),and the efficacy in group B was significantly better than that in group A(P<0.05). There was no significant difference in neurofunction between the two groups (P>0.05). Conclusion:The fixation method through the injured vertebra had a better reduction effect,more stable fixation,and a better long-term effect on vertebral morphology than that across the injured vertebra in the treatment of thoracolumbar vertebral fractures.