经伤椎置入单向与万向椎弓根螺钉的6钉内固定方法治疗胸腰椎骨折疗效分析

目的：探讨经伤锥置入单向椎弓根螺钉与万向螺钉的内固定治疗胸腰椎骨折治疗效果的差别。方法选取行传统后路经伤锥置入椎弓根螺钉的6钉内固定治疗的无脊髓神经损伤胸腰椎骨折患者52例，随机分为2组：观察组（ n ＝24，置入万向钉组）和对照组（ n ＝28，置入单向钉组），2组均行经伤锥置钉的开放后路3椎体6钉内固定治疗术。比较2组病例一般情况，术前、术后1、3、6、12个月伤锥前（后）缘高度、矢状位Cobb角变化，应用疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）评价患者疼痛、椎体功能情况，并对手术时间、术中出血量、住院时间及术后并发症发生情况进行比较。结果2组矢状位Cobb角比较，差异无统计学意义（ P＞0．05）。2组比较伤锥前（后）缘高度，仅术后12个月2组该指标比较差异有统计学意义（P＜0．05），2组同时间段VAS、ODI差异无统计学意义（P＞0．05），2组术中出血量、住院时间比较差异均无统计学意义（P＞0．05）；观察组手术时间较对照组显著缩短，差异有统计学意义（P＜0．05），观察组内固定失败率较对照组明显降低（P＜0．05）。结论经伤锥置入万向椎弓根螺钉与单向椎弓根螺钉内固定治疗胸腰椎骨折疗效相似，均能有效恢复骨折椎体高度、矫正后凸畸形，而置入万向椎弓根螺钉能够有效降低并发症发生率，提高内固定成功率，是安全有效的临床治疗胸腰椎骨折的方式。

Comparison of the therapeutic effects of 6-screw internal fixation with monoaxial pedicle screw or polyaxial pedicle screw via injured vertebra on thoracolumbar fracture

Objective To investigate the differences of therapeutic effects of 6-screw internal fixation with monoaxial pedicle screw or polyaxial pedicle screw via injured vertebra on thoracolumbar fracture .Methods Fifty-two patients with thoracolumbar fracture without spinal nerves injury who underwent traditional posterior route 6-screw internal fixation into pedicle of vertebral arch via injured vertebra in our hospital from January 2011 to January 2015 were randomly divided into two groups:observation group ( polyaxial pedicle screw internal fixation , n =24 ) and control group ( monoaxial pedicle screw internal fixation, n =28),the patients in both groups were treated by open posterior route 3 vertebraes 6-screw internal fixation operation.The general status of patients , the height in anterior edge and posterior edge of injured vertebra before operation and on 1m,3m,6m,12m after operation,the changes of sagittal Cobb angle were observed and compared between two groups .The visual analog scale (VAS) and Oswestry dysfunction index (ODI) were used to evaluate patients'pain, vertebral function status,moreover the operative time , intraoperative hemorrhage volume , the incidence rates of complications in hospitalization and after operation were observed and compared between two groups .Results There were no significant differences in patients’ gender and age , fracture type and the other general status between two groups .Moreover there was no significant difference in sagittal Cobb angle between two groups ( P >0.05).there was significant difference in the height in anterior edge and posterior edge of injured vertebra only on 12 months after operation between two groups ( P <0.05),however, there were no significant differences in VAS,ODI at the same time points between two groups ( P >0.05).There were no significant differences in intraoperative hemorrhage volume and the length of staying in hospital between two groups ( P >0.05).The operative time in observation group was significantly shorter than that in control group ( P <0.05).The failure rate of internal fixation in observation group was significantly decreased ,as compared with that in control group ( P <0.05). Conclusion The therapeutic effects of 6-screw internal fixation with monoaxial pedicle screw and polyaxial pedicle screw via injured vertebra on thoracolumbar fracture are similar ,both methods can effectively recover vertebral height of injuried centrum vertebrae, correct kyphosis,however, polyaxial pedicle screw internal fixation can effectively decrease incidence rates of complications and increase success rate of internal fixation , thus, which is an effective and safe therapeutic method for thoracolumbar fractures.