单节段与双节段经伤椎椎弓根钉固定治疗轻中度不稳定胸腰椎骨折的疗效

 目的 比较单节段与双节段经伤椎椎弓根钉固定治疗轻中度不稳定胸腰椎骨折的临床疗效。方法 2006年6月至2011年6月采用单节段或双节段经伤椎椎弓根钉固定治疗并获得1年以上随访的轻中度胸腰椎骨折患者45例，男22例，女23例；年龄23~76岁，平均43.8岁。单节段固定31例，双节段固定14例。术前、术后第3天和末次随访时测量伤椎及其上、下相邻正常椎体的前缘高度、伤椎后凸Cobb角，比较两组的椎体压缩率、矫正度丢失、手术时间和术中出血量。结果 随访13~57个月，平均24.8个月。末次随访时单节段固定组患者满意率93.5%、双节段固定组92.9%。术前单节段固定组椎体压缩率为44.67%±4.6%、双节段固定组45.49%±8.9%，Cobb角分别为24.6°±4.2°、25.8°±5.8°，差异无统计学意义。术后第3天两组椎体压缩率分别为9.34%±5.2%、8.68%±4.5%，Cobb角分别为9.2°±1.6°、8.8°±3.1°，差异无统计学意义。末次随访时两组椎体压缩率分别为11.83%±4.2%、10.12%±2.5%，Cobb角分别为10.5°±1.3°、9.8°±3.8°，差异无统计学意义；与术后第3天相比，差异无统计学意义。两组手术时间分别为(90±35)、(110±42) min，术中出血量分别为(240±48)、(380±52) ml，差异有统计学意义。结论 对轻中度不稳定胸腰椎骨折，单节段与双节段经伤椎固定均能较好地恢复椎体高度和Cobb角，近期随访未发现明显矫正度丢失。双节段经伤椎固定手术时间相对较长、出血量相对较多。

Comparison of clinical outcomes of mono-segmental and bi-segmental transvertebral pedicle crews internal fixation for mild-to-moderate unstable thoracolumbar fracture

Objective To compare the clinical outcomes of mono- and bi-segmental transvertebral pedicle screws internal fixation for mild-to-moderate unstable thoracolumbar fracture. Methods The data of 45 patients with mild-to-moderate thoracolumbar burst fracture were retrospectively studied, who underwent mono- or bi-segmental transverteral pedicle screws internal fixation from June 2006 to June 2011. The anterior height of the injured vertebrae and the adjacent two normal vertebrae, and the Cobb angle of the injured vertebrae were measured. The compression rate, the loss of correction, the operation time, and blood loss of the two groups were compared. Results The follow-up time was 24.8 months on average. At the final follow-up, the compression rate before operation was 44.67%±4.6% and 45.49%±8.9%, while the Cobb angle was 24.6°±4.2° and 25.8°±5.8° respectively. No significant difference was found between the two groups. The compression rate after operation was 9.34%±5.2% and 8.68%±4.5%, while the Cobb angle was 9.2°±1.6° and 8.8°±3.1° respectively. The compression rate was 11.83%±4.2% and 10.12%±2.5%, while the Cobb angle was 10.5±1.3° and 9.8°±3.8° respectively. No significant difference was found between the two groups in post-operation data and final follow-up data. In mono- and bi-segmental group, the operation time was 90±35 and 110±42 min respectively, and the blood loss was 240±48 and 380±52 ml respectively. Significant difference was found between the two groups. Conclusion For mild-to-moderate unstable thoracolumbar fracture, both mono- and bi-segmental fixation can restore the vertebral height and Cobb angle well, short-term results did not show severe loss of correction. The first group has a shorter operation time and less blood loss.