经伤椎单、双侧置钉内固定治疗胸腰椎骨折的疗效

目的探讨经伤椎单、双侧置钉内固定治疗胸腰椎骨折的疗效。方法采用后路短节段内固定治疗76例胸腰椎单一椎体骨折患者,按内固定方式的不同分成3组:跨伤椎4钉固定(A组)30例,伤椎单侧5钉固定(B组)16例,伤椎双侧6钉固定(C组)30例。比较3组患者术中出血量、手术时间、术后伤椎高度矫正率、末次随访伤椎高度和后凸角的矫正丢失率、内固定失效等。结果 3组患者术中出血量、手术时间及术后伤椎高度矫正率比较差异均无统计学意义(P0.05)。患者均获得随访,时间13~28个月。末次随访伤椎高度和后凸角的矫正丢失率:A组差于B、C组,差异具有统计学意义(P0.05,P0.01),B、C两组比较差异无统计学意义(P0.05)。B、C两组未出现断钉断棒等现象,A组有3例断钉。结论与传统的后路跨伤椎短节段内固定相比,经伤椎单、双侧置钉治疗胸腰椎骨折均能获得良好的复位和固定效果,内固定失效率低。

The clinical effects of thoracolumbar fractures treated with unilateral or bilateral injured ver-tebra transpedicular fixation

Objective To explore the clinical effects of thoracolumbar fractures treated with unilateral or bilateral in -jured vertebra transpedicular fixation .Methods Seventy-six single thoracolumbar fractures were treated by posterior short-segment pedicle screw fixation .According to the different fixation methods , they were divided into three groups:cross segment four pedicle screws fixation (group A,n=30), unilateral injured vertebra five pedicle screws fixation (group B,n=16) and bilateral injured vertebra six pedicle screws fixation (group C,n=30).These three groups were compared by intra operative blood loss , operation time , the rate of injured vertebra height correction postopera-tively and the losing rate of injured vertebra height and kyphosis angle correction , implant failures at the latest follow-up and so on.Results There was no significant difference in the intraoperative blood loss , operation time, the rate of injured vertebra height correction postoperatively among the three groups (P>0.05).All patients were followed up for 13~28 months.However, for the losing rate of injured vertebra height or kyphosis angle correction at the latest follow-up, group B and C had better significant difference than group A (P<0.05,P<0.01), and there wasn′t sig-nificant difference between group B and C (P>0.05).Additionally, group A had three patients which were suffered with pedicle screw breakage , then group B and C hadn′t occurred .Conclusions As to the cross of injured vertebra posterior short-segment pedicle screw fixation , the treatment of thoracolumbar fractures with unilateral or bilateral in-jured vertebra transpedicular screw fixation can obtain satisfactory restoration and fixation effect ,and decrease the rate of implant failures .