3种手术方式治疗胸腰椎不稳定骨折的疗效对比

目的比较3种术式治疗不稳定胸腰椎骨折的临床疗效。方法对不稳定胸腰椎骨折86例行胸腰椎后路手术治疗,随机分为3组：A组（传统内固定）经骨折相邻的上下位椎体椎弓根钉内固定椎板间或横突间植骨;B组在A组基础上行伤椎椎弓根短钉内固定;C组在A组基础上行经伤椎椎弓根植骨。结果 3组切口长度、手术时间、手术出血量比较差异无统计学意义（P〉0.05）。术后1年或内固定取出后,比较椎体前后缘比值及Cobb角,B、C两组优于A组,且C组优于B组（P〈0.05）;比较内固定失效率,B、C两组优于A组（P〈0.01）。结论不稳定胸腰椎骨折经伤椎椎弓根植骨在取出内固定后能有效维持椎体高度,矫正后凸成角,防止椎体塌陷,减少内固定失败、椎体再压缩等并发症。

Comparison of curative effects among three surgical methods on thoracolumbar unstable fracture

Objective To make comparison of curative effects among three surgical methods on thoracolumbar unstable fracture.Methods Eighty six patients with thoracolumbar unstable fracture received posterior approach and were randomly divided into three groups.Group A received(traditional internal fixation)bone grafting via internal vertebral plates fixed by pedicle screws in the upper and lower vertebrae near the fracture region or via processus transversus;group B received internal fixation by pedicle short screw in the injured vertebrae based on the same treatment that was received by group A;group C received bone grafting via the vertebral arch pedicle of the injured vertebrae based on the same fixation that was received by group A.Results There was no significant difference in length of incision,operation time and blood loss during operation among the three groups(P>0.05).One year after the operation or after the removal of the implants,comparison was made in the ratio of centrum anteroposterior margin and Cobb angle.Those indexes of group B and C were superior to those of group A,and those of group C were superior to those of group B(P<0.05).As the comparison in failure rate of internal fixation,group B and C were better than group A(P<0.01).Conclusion After the removal of the implants,the treatment of thoracolumbar unstable fracture by bone crafting via the vertebral arch pedicle of the injured vertebrae can effectively maintain the height of centrum,rectify the kyphosis angle,prevent vertebral collapse and reduce complications such as failure of internal fixation and centrum recompression,etc.