经第11和12肋骨两种手术入路对L1爆裂骨折前路手术置钉角度影响的比较研究

目的:比较经第11肋骨和第12肋骨两种手术入路对L1爆裂骨折前路手术中置钉的角度,探讨两种手术入路对置钉和术后侧方成角的影响。方法:对2007年10月至2010年10月经前路手术治疗资料完整的108例L1椎体爆裂性骨折患者的临床资料进行分析,其中男68例,女40例;年龄21～64岁,平均38.22岁。根据手术入路平面分为经第11肋骨入路组(A组,51例)和经第12肋骨入路组(B组,57例)。观察两组的手术时间、出血量、切口区疼痛持续时间及随访时JOA下腰痛评分、Oswestry功能障碍评分、VAS疼痛评分、生活质量(SF-368个维度)、神经功能恢复情况,测量并比较两组患者的术前、术后及随访时的冠状面Cobb角,术后椎体螺钉与相应终板的夹角。结果:两组患者均获随访,时间9～37个月,平均23个月。A组的手术时间、出血量、切口区疼痛持续时间均较B组少(P<0.05);两组患者的JOA下腰痛评分、Oswestry功能障碍评分、VAS疼痛评分、SF-368个维度、神经功能的恢复差异无统计学意义(P>0.05)。两组患者术前冠状面Cobb角差异无统计学意义(P>0.05),而术后Cobb角差异有统计学意义(P=0.000)。两种手术入路椎体螺钉与相应终板夹角差异均有统计学意义(P=0.001,P=0.003)。结论:经第11肋骨手术入路对椎体螺钉置钉的影响小,手术创伤较小,术后脊柱侧方成角较轻,是前路手术治疗L1椎体爆裂性骨折相对较好的手术入路选择。

Comparison of screw' inserting angle through the 11th and 12th rib anterior approaches for L1 burst fracture

Objective:To compare screw's inserting angle through the 11th and 12th rib in treating L₁ burst fracture,explore effects on inserting screw and postoperative angle. Methods:From October 2007 to October 2010,108 patients with L₁ brust fracture treated through anterior approach were analyzed,including 68 males and 40 females,aged from 21 to 64 years(mean 38.22 years). All patients were divided into the 11th (A,51 cases) and 12th(B,57 cases) approach. The data of operation time,blood loss,duration of incision pain,JOA score,Oswestry score,VAS score,quality of life(SF-36),recovery of nervous function,coronal Cobb angle,included angle between screw and plate were observed. Results:All patients were followed up for 9 to 37 months,mean 23 months. The operation time,blood loss,duration of incision pain,in group A were lower than group B(P<0.05),JOA score,Oswestry score,VAS score,SF-36,recovery of nervous function had no significant differences(P>0.05). There were no differences in Cobb angle before operation,but had significance after operation(P=0.000). There were statistically significance between two group in angle between screw and plate(P=0.000,P=0.003). Conclusion:The 11th rib approach for the treatment of L₁ burst fracture has less effects on screw,less trauma and less angle between screw and plate.