经伤椎短钉置钉后路复位内固定治疗单节段压缩性胸腰椎骨折

目的 探讨后路经伤椎椎弓根短钉置钉短节段复位内固定治疗单节段压缩性胸腰椎骨折的有效性和安全性。方法 回顾性分析2010年1月至2012年1月间于我院手术的单节段压缩性胸腰椎骨折患者87例的临床资料。根据手术方法的不同将患者分为经伤椎短钉置钉后路减压复位内固定术（伤椎置钉组）和常规后路减压复位短节段融合内固定术组（短节段固定组）。统计手术时间和术中出血量，评估患者术后疼痛；收集术前、术后即刻及术后1年随访数字射线摄影（DR）侧位片上的伤椎上、下椎体Cobb角、伤椎椎体前缘高度（前高），计算伤椎前高压缩比。结果 共73例患者有完整的随访资料，其中伤椎置钉组38例，短节段固定组35例。术前两组年龄、伤椎前高压缩比和Cobb角比较差异无统计学意义。伤椎置钉组手术时间长于短节段固定组（121 min vs 92 min，P<0.05），术后即刻及术后1年椎体前高压缩比均高于短节段固定组术后即刻91.3%（82%～93%）vs 77.2%（73%～86%），P<0.05；术后1年87.2%（79%～93%）vs 73.1%（68%～80%），P<0.05]，术后1年伤椎的上、下椎体Cobb角小于短节段固定组7.8°（0°～15°）vs 11°（2°～17°），P<0.05]。手术出血量、疼痛评分两组比较差异无统计学意义。结论 后路经伤椎椎弓根短钉置钉短节段复位内固定治疗单节段压缩性胸腰椎骨折能安全、有效地重建椎体高度，矫正脊柱后凸畸形。

Posterior reduction and short pedicle screw fixation at fracture level for treatment of single level compress thoracolumbar fractures

Objective To assess the efficacy and safety of posterior reduction and short pedicle screw fixation at fracture level (method A) for treatment of single level compress thoracolumbar fractures. Methods The clinical data of 87 patients with single level compress thoracolumbar fractures, who were surgically treated between January 2010 and January 2012 in our hospital, were retrospectively analyzed. treated by posterior. The patients were divided into two groups according to surgical methods. Group A: Patients were treated with method A; Group B: Patients were treated by conventional posterior decompression, redultion of fracture and short segment fusion and internal fixation. The operation time and intraoperative blood loss were recorded and the postoperative pain was evaluated. The adjacent vertebral Cobb angle and the anterior height of the injured vertebra on the lateral radiographs were measured before surgery, immediately after surgery, and 1 year after surgery, and the vertebral compression ratio was calculated. Results Among the 73 patients who were finally included in the study, 38 were in group A and 35 in group B. There were no significant differences in patient age, compression ratio, Cobb angle before or after surgery between the two groups. The operation time in group A was signficantly longer than that in group B(121 min vs 92 min,P<0.05); the compression ratios immediately and 1 year after surgery in group A were significantly higher than those in group B (immediately after surgery: 91.3% (82%-93%) vs 77.2% (73%-86%), P<0.05; 1 year after sugtery: 87.2% (79%-93%) vs 73.1%(68%-80%),P<0.05]). The Cobb angle at 1 year after operation in group A was significantly smaller than that in group B (7.8°0°-15°] vs 11°2°-17°],P<0.05). There was no significant differences in blood loss or scores of low back pain between the two groups. Conclusion Posterior reduction and short pedicle screw fixation can safely and effectively reconstruct the vertebral body height and correct kyphosis in patients with single level compress thoracolumbar fractures.