胸腰段多椎体不稳定骨折内固定方式的选择

目的：探讨胸腰段多椎体不稳定骨折内固定手术方式的选择。方法对2010年3月至2013年11月东莞市石龙人民医院和东莞市高埗医院收治的110例胸腰段多椎体不稳定骨折患者采取不同的内固定手术方式，其中长节段固定组42例、短节段固定组38例、前路固定组30例。比较3组术前、术后即刻及末次随访时伤椎椎体前缘高度、后凸角度以及疼痛视觉模拟量表（VAS）评分、Oswestry功能障碍指数（ODI）的差异。结果110例患者随访6～18个月，平均随访时间（12.3±2.1）个月。各组患者术前、术后即刻、末次随访不同时相点伤椎椎体前缘高度和后凸角度比较，差异均有统计学意义（P＜0.05），其中术后即刻和末次随访时椎体前缘高度和后凸角度均较术前明显改善（P＜0.05），而术后即刻与末次随访时比较，差异无统计学意义（P＞0.05），椎体前缘高度和后凸角度未见明显丢失。末次随访时3组VAS及ODI评分均较术前明显下降（P＜0.05），但组间比较差异无统计学意义（P＞0.05）。结论根据骨折类型及脊髓损伤情况选择合理的内固定方式，对胸腰段多椎体不稳定骨折患者进行个体化治疗，可获得满意的临床效果。

Internal fixation options for unstable thoracolumbar multiple-level spinal fractures

Objective To discuss the internal fixation options for unstable thoracolumbar multiple-level spinal fractures （MSF）. Methods From March 2010 to November 2013, 110 patients with unstable thoracolumbar MSF were treated surgically in Shilong People＆#39;s Hospital and Gaobu Hospital of Dongguan City. According to different internal fixation techniques, they were divided into 3 group, posterior long-segment fixation group （n =42）, posterior short-segment fixation group （n = 38） and anterior internal fixation group （n = 30）. At preoperation, postoperation and the latest follow-up, the differences of anterior vertebral body height, kyphotic angle, visual analogue scale （VAS） score and Oswestry disability index （ODI） were compared among 3 groups. Results All patients were followed up for 6 to 18 months, with the average of （12.3 ± 2.1） months. Differences of anterior vertebral body height and kyphotic angle in 3 groups had statistical significance among different timepoints （P〈0.05）, in which the above parameters at postoperation and the last follow-up improved significantly compared with preoperative ones （P 〈0.05）, while there was no statistical difference between postoperation and the last follow-up （P 〉0.05）, no obvious loss of anterior vertebral body height or kyphotic angle were found. Also, compared with preoperative ones, VAS, ODI scores at the latest follow-up all achieved significant improvement （P 〈0.05）, while there was no statistical difference among 3 groups （P 〉0.05）. Conclusion Through individualized treatment according to fracture types and damage of spinal cord, reasonable internal fixation options for unstable thoracolumbar MSF could obtain satisfied clinical effects.