经伤椎单侧置钉并椎体内植骨短节段内固定治疗胸腰椎骨折疗效观察

目的 探讨经伤椎单侧置钉并椎体内植骨内固定治疗胸腰椎骨折的临床效果.方法 随机选取2007年5月至2015年4月在我院接受经伤椎单侧置钉并椎体内植骨短节段椎弓根钉棒系统内固定治疗的41例胸腰椎骨折患者作为观察组,随机选取同时期接受单纯椎体后外侧植骨短节段椎弓根钉棒系统内固定治疗的41例胸腰椎骨折患者作为对照组.比较两组患者的临床疗效.结果 两组患者术后6个月伤椎前缘高度观察组为(22.3±1.7)%,对照组为(21.1±1.5)%]均显著高于术前观察组为(3.4±1.4)%,对照组(6.7±1.6)%],差异均有显著统计学意义(P<0.01);术后6个月脊柱Cobb's角、伤椎椎体楔形变角(观察组分别为(44.2±4.6)°、(7.7±5.8)°,对照组分别为(47.1±4.7)°、(11.5±5.9)°]显著低于术前观察组分别为(83.4±5.2)°、(22.1±6.1)°,对照组分别为(84.2±5.1)°、(21.9±6.2)°],且术后观察组均显著优于对照组,差异均有显著统计学意义(P<0.01);术后两组疼痛视觉评分(VAS)及Oswestry功能障碍指数(ODI)评分观察组分别为(1.62±1.26)分、(14.3±7.9)分,对照组分别为(3.32±1.32)分、(14.4±7.7)分]均显著低于术前观察组分别为(8.71±1.60)分、(42.4±8.2)分,对照组分别为(8.91±1.54)分、(42.2±7.9)分],且术后6个月观察组VAS显著低于对照组,差异均有显著统计学意义(P<0.01),但ODI在术后6个月时两组比较差异无统计学意义(P>0.05);两组患者神经功能改善率相当,差异无统计学意义(81.7%vs 79.9%,P>0.05).结论 经伤椎单侧置钉并椎体内植骨、联合椎体后外侧植骨短节段椎弓根钉棒系统内固定治疗胸腰椎骨折,能够更好的恢复伤椎高度、脊柱生理曲度以及脊柱稳定性,疗效确切,值得推广.

Effect of unilateral pedicle screw fixation combined with bone graft in the treatment of thoracolumbar fractures

Objective To discuss the clinical effects of unilateral pedicle screw fixation combined with bone graft in the treatment of thoracolumbar fractures. Methods Forty-one patients with thoracolumbar fractures in our hos-pital from May 2007 to April 2015 treated by unilateral pedicle screw fixation combined with vertebral body bone graft and posterolateral bone graft were selected as the observation group. In the same period, 41 patients with thoracolumbar fractures treated by posterolateral bone graft to vertebral body were selected as the control group. The clinical efficacy of the two groups were analyzed and compared. Results The vertebral height ratio six months after treatment was signifi-cantly increased compared with before treatment (22.3%± 1.7)% vs (3.4%± 1.4)% in the observation group, (21.1%± 1.5)%vs (6.7%±1.6)%in the control group]. Cobb's angle (44.2±4.6)° vs (83.4±5.2)°, (47.1±4.7)° vs (84.2±5.1)°] and in-jured vertebral wedge angle (7.7±5.8)° vs (22.1±6.1)°, (11.5±5.9)° vs (21.9±6.2)°] reduced significantly 6 months after the surgery than before treatment, P<0.01, and values after treatment in the observation group were significantly better than those in the control group (P<0.01). VAS score (1.62 ± 1.26) vs (8.71 ± 1.60), (3.32 ± 1.32) vs (8.91 ± 1.54)] and ODI score (14.3 ± 7.9) vs (42.4 ± 8.2), (14.4 ± 7.7) vs (42.2 ± 7.9)] were significantly reduced 6 months after surgery, P<0.01. VAS score after surgery in the observation group was significantly lower than that in the control group (P<0.01), but no significantly difference was found in ODI between the two groups (P>0.05). No significant difference was found in the improvement rate between the two groups (81.7%vs 79.9%, P>0.05). Conclusion In the treatment of thoracolumbar fractures, unilateral pedicle screw fixation combined with vertebral body bone graft and posterolateral bone graft can bet-ter restore vertebral height, physiological curvature of the spine and spinal stability, which is worthy to be popularized.