不同胸腰椎前路内固定系统对术后脊柱侧方成角的影响分析

目的 通过分析胸腰椎前路内固定系统与术后脊柱侧方成角的关系，探讨内固定系统对脊柱前路手术后脊柱侧方成角的影响。方法 回顾性分析2004年5月至2008年1月经前路治疗且获得随访的胸腰椎骨折患者172例，男124例，女48例；年龄15～ 70岁，平均39.0岁。根据应用的内固定系统不同分为4组：Z-plate组（63例）、Antares组(45例)、Profile组(50例)及单钉棒组(14例)。测量并比较各组术前、术后、未次随访时冠状面Cobb角大小、各组间冠状面Cobb角大小，及各组间不同程度侧方成角的比例。结果 所有患者术后获8～49个月（平均39个月）随访。本组患者术前Cobb角-14.3°～14.6°，平均0.8°±3.9°；术后Cobb角-8.2°～14.0°，平均3.2°±4.1 °；末次随访时Cobb角-1.1°～ 17.3°，平均3.5°±4.2°。术后及未次随访时与术前比较Cobb角差异均有统计学意义(P＜0.05)，术后与末次随访时比较差异无统计学意义(P＞0.05)。4组患者各时间点冠状面Cobb角比较差异均无统计学意义(P＞0.05)。4组患者术后出现不同程度侧方成角的比例比较差异均无统计学意义(P＞0.759)。结论 胸腰椎骨折前路手术后脊柱侧方成角与使用内固定系统的种类无关。

Association between anterior internal fixation systems and post-operative lateral angulation in thoracolumbar fractures

ObjectiveTo explore the effects of the anterior internal fixation systems on the post-operative lateral angulation in treatment of thoracolumbar fractures.Methods A retrospective study was done to analyze the 172 patients who had been consecutively treated by anterior internal fixation for thoracolumbar fractures between May 2004 and January 2008. They were 124 men and 48 women, with a man age of 39.0 years (from 15 through 70 years) . According to the internal fixation system, they were divided into 4 groups: Z-plate (63 cases), Antares (45 cases), Profile (50 cases) and Mono-screw-rod ( 14 cases).Radiographic scans were used to measure and compare the coronal Cobb angles between preoperation and postoperation as well as between the 4 groups.Results All the patients were followed up for 8 to 49 months (mean, 39 months) . The mean coronal Cobb angle was O. 8°±3.9° before operation, 3. 2°±4. 1°immediately after operation, and 3.5° ± 4. 2° at the final follow-up. In all the cases and the 4 groups, the postoperative lateral angulation was significantly larger compared to preoperation ( P ＜ 0. 05), but there was no significant difference between the last follow-up and postoperation ( P ＞ 0. 05). There were no significant differences in multiple comparison of postoperative coronal Cobb angles between the 4 internal fixation systems ( P ＞ O. 05) . There were no significant differences in ratio of postoperative lateral angulation between the 4internal fixation systems either ( P ＞ 0.05).Conclusion The current internal fixation systems are not associated with the postoperative lateral angulation in treatment of thoracolumbar fractures.