后路椎弓根钉不同节段固定治疗重度胸腰段脊柱骨折的效果观 察简

目的 比较后路椎弓根钉不同节段固定术式对重度胸腰段脊柱骨折疗效的影响.方法 选择2009年1月～2012年12月浙江省永康市第一人民医院与武警浙江总队医院96例重度胸腰段脊柱骨折患者,分别采用短节段固定（A组,59例）、长节段固定（B组,23例）、经伤椎短节段固定（C组,14例）三种术式,术后均随访半年以上,比较三组手术情况、伤椎前缘压缩比、Cobb角以及Oswestry评分.结果 三组手术时间比较,A组＜C组＜B组,差异均有统计学意义（P＜0.05）;三组术中出血量比较,A组＜C组＜B组,差异均有统计学意义（P＜0.05）;B组、C组术后伤椎前缘压缩比优于A组（P＜0.01）,B组、C组术后Cobb角恢复优于A组（P＜0.05）;B组、C组间术后伤椎前缘压缩比、Cobb角差异无统计学意义（P＞0.05）.术后6个月三组Oswestry功能评分比较差异无统计学意义（P＞0.05）.结论 短节段固定手术简便,手术时间短,出血量少;长节段固定和经伤椎短节段固定在保持椎体高度和复位方面效果更好;三种术式短期神经功能恢复无显著差异.

Comparison of clinical effect of pedicle fixation in different segments for severe thoracolumbar spine fractures

Objective To compare the clinical effect of pedicle fixation in different segments for treatment of serious thoracolumbar spine fracture.Methods 96 patients in the First People＇s Hospital of Yongkang City and Armed Police Corps Hospital in Zhejiang Province from January 2009 to December 2012 were selected.59 cases with short segment fixation were divided into group A,23 cases with long segment fixation were divided into group B,and 14 cases with short segment fixation at the level of the fracture were divided into group C.All patients were followed up for 6 months,the operation situation,injured vertebral frontal compression ratio,Cobb angle and Oswestry function scores were com pared.Results The operating time comparison,group A 〈 group C 〈 group B,there were significant differences （P 〈 0.05）; blood loss comparison,group A 〈 group C〈 group B,there were significant differences （P 〈 0.05）.The injured vertebral frontal compression ratio of group B and group C were better than group A （P 〈 0.01）,the Cobb angle of group B and group C were better than group A （P 〈 0.05）,but the injured vertebral frontal compression ratio and Cobb angle between group B and group C had no statistically significant difference （P 〉 0.05）.6 months after operation,the Oswestry function score among the three groups had no statistically significant differece （P 〉 0.05） Conclusion Short segment fixation is simple and easy in operation,has less blood loss; long segment fixation and short segment fixation at the level of the fracture are superior to keep the vertebral body height and restoration.There is no difference in neural function recovery among these three groups.