经伤椎椎弓根螺钉三椎体固定治疗胸腰椎爆裂性骨折的前瞻性研究

目的 比较经伤椎椎弓根螺钉三椎体固定与传统短节段固定治疗胸腰椎爆裂性骨折的临床疗效.方法 2004年5月至2007年6月收治胸腰椎爆裂性骨折患者48例,随机分为经伤椎椎弓根螺钉三椎体固定组(治疗组24例)和传统短节段固定组(对照组24例),其中治疗组行伤椎及伤椎上下节段椎弓根内固定,对照组行传统4钉内固定.所有患者术前及术后随访均行X线及CT检查,测量并比较两组Cobb角大小、伤椎前缘压缩率、椎管占位率、椎体平移率,同时观察植骨融合及神经恢复情况.结果 所有患者获得6～18个月(平均10.6个月)随访,两组患者术后各项指标较术前均有明显改善,内固定未见松脱断裂,植骨均获得骨性愈合,无完全神经损伤较术前有1～2级恢复,术后脊髓神经功能无损伤加重等.随访时治疗组Cobb角大小、伤椎前缘压缩率较对照组差异有统计学意义(P<0.05),显示治疗组固定更牢固,随访矫正丢失少.椎管占位率和椎体平移率治疗组疗效更好,但差异无统计学意义(P>0.05).结论 经伤椎椎弓根螺钉三椎体固定法较传统方法具有更加牢固的固定效果,前中柱重建稳定,后柱固定牢固,矫正度丢失小,疗效满意,是治疗胸腰椎爆裂性骨折的有效方法.

Treatment of thoracolumbar burst fractures with transpedicular fixation through the pedicle of fractured vertebra: a prospective randomized trial

Objective To compare the therapeutic results of transpedicular fixation through the pedicle of fractured vertebra and of the traditional transpedicular fixation for treatment of thoracolumbar burst fractures. Methods Between May 2004 and June 2007,48 consecutive patients seeking medical treat-ment for one level thoracolumbar burst fracture in our department were included in this study. Their average age was 40. 1 yeas old. They were randomly and evenly assigned into an experimental group of transpedicular fixation through the pediele of fractured vertebra and a control group of traditional transpedicular fixation. All patients underwent X-ray and spiral CT scan preoperatively and postoperatively. The Cobb's angle,anterior vertebral body compression percentage (AVCP),sagittal canal diameter (SCD) and vertebral body translation percentage (VBTP) were recorded for all patients. Their fusion results and neurological functions were ob-served. Results All patients were followed up for 10.6 months averagely. The shape of injured ver-tebrae was maintained and fusion of the grafted bone was observed in all patients. All parameters were improved after operation. Follow-ups revealed that the mean Cobb's angle and AVCP in the experimental group were 6.99°±6.81°and 18.60%±9.96% respectively,significantly lower than those in the con-trol group (P<0.05). The SCD and VBTP in both groups were nearly equal (P>0.05) . No com-plications were observed in either group. The preoperative incomplete neurological injuries obtained postop-erative improvement of one or two grades. Conclusion Transpedicular fixation through the pedicle of fractured vertebra is a better treatment for thoracolumbar vertebral fractures than the traditional transpedicular fixation,because its safer fixation and better stability help restore the shape of injured vertebra and reduce the Cobb's angle.