采用椎弓根螺钉经伤椎固定与不经伤椎固定治疗下腰椎骨折疗效对比分析

目的：对比分析采用跨伤椎固定与经伤椎固定治疗下腰椎骨折的疗效。方法：回顾性分析2009年1月～2010年12月分别采用椎弓根螺钉经伤椎固定与不经伤椎固定治疗的56例下腰椎骨折，其中男41例，女15例；年龄21~46岁，平均41．5岁。损伤部位：L3 27例，L4 16例，L5 13例。按AO分型：A1．2型6例，A3．1型29例，A3．2型9例，A3．3型12例。载荷评分5-8分，平均6-3分。脊髓神经损伤按ASIA分级：B级3例，C级4例，D级8例。采用椎弓根螺钉不经伤椎固定27例，经伤椎固定29例，两组患者均选择性进行单节段植骨融合。对比两组患者术前、术后和最后随访时的Cobb角、伤椎前缘高度恢复及椎管占位情况的变化。随访过程中过程中观察植骨融合和马尾神经恢复情况。采用Denis评分比较两组患者局部疼痛和工作状态的恢复差异。结果：所以患者获随访12—48个月，平均25．8个月。不经伤椎固定1例于术后3个月出现棒松动，其余未出现内松动或断裂现象。在术后Cobb角矫正、椎体前缘高度恢复、椎管占位率恢复及最后随访时椎体前缘高度恢复和椎管占位保持方面两组差异无统计学意义（P〉0．05）。术后两组患者矫正度均存在丢失现象，不经伤椎固定组最后随访时的Cobb角与术后比较差异的统计学意义（P〈0．05），经伤椎固定组最后随访时的Cobb角与术后比较差异无统计学意义（P〉0．05），两组间Cobb角矫正度丢失率差异有统计学意义（P〈0．05）。不经伤椎固定组植骨融合21例（78％），经伤椎固定组植骨融合27例（93％）（P〈0．05）。在局部疼痛评分上，经伤椎固定组优于不经伤椎固定组（P〈0．05），而在工作状态的恢复方面两组差异无统计学意义（DO．05）。结论：相对不经伤椎固定，经伤椎固定治疗下腰椎骨折能够获得较高的植骨融合率，同时能更好的维持脊柱矫正度，是下腰椎骨折后路治疗的较好选择。

Curative effect analysis of pedicle screws fixation via and un-via the injured vertebrae for treatment of lower lumbar vertebral fracture

Objective： To compare the clinical results of pedicle screw fixation via and un-via the injured vertebra for treatment of lower lumbar spinal fracture. Methods： From Jan. 2009 to Dec. 2010, the data of 56 lower lumbar vertebral fracture patients （41male and 15 female） were retrospectively analyzed. According to the AO classification, there were 6 patients with type A1.2, 29 with type A3.1,9 with type A3.2 and 12 with type A3.3. McCormck load score was 5-8 （mean 6.3）. Among the 56 patients, 27 of them underwent pedicle screw fixation via the injured vertebra （group A） and the rest 29 patients were fixed did not via the injured vertebra （group B）. The Cobb＇s angle, recovery of anterior height of injured vertebra, improvement of spinal canal stenosis rate and Denis scale in local pain and work status were compared before, after and last follow-up visit between the two groups. Results： All patients were followed up for 12~48 month （aver- age 25.8 months）. Implantation loosening occurred in 1 of group B patient 3 months after operation. There was no significant difference between 2 groups in correction of Cobb＇s angle, restoration of the anterior height of injured vertebra and improvement of spinal canal stenosis rate postoperatively as well as in restoration of anterior height of injured vertebra and improvement of spinal canal stenosis rate at the latest follow-up visit （P〉0.05）. Postoperative correction loss of Cobb＇s angle was noted in both groups.The difference of Cobb＇s angle after operation and the last visit was significant in group B （P〈O.05） and in- significant in group A （P〉0.05）. Bone graft fusion noted in 21 patients of group B （78%） and 27 patients of group A （93%）, （P〈0.05）. Besides, the clinical effect of group A was better than that of group B in local pain （P〈O.05）, but no statistically significant in work status between the two groups （P〉0.05）. Conclusions： Pedicle screw fixation via the injured vertebra can obtain a higher fusion rate and a better correction rate of Cobb＇s angle, which is a good choice for treating lower lumbar vertebral fracture by posterior approach.