伤椎置钉与跨节段椎弓根螺钉内固定术治疗胸腰椎骨折的比较研究

目的比较经伤椎置钉与跨节段椎弓根螺钉固定治疗胸腰椎骨折的临床疗效。方法选择汕头市潮阳区大峰医院于2010年1月至2012年6月收治的胸腰椎爆裂性骨折80例,随机分为经伤椎椎弓根螺钉三椎体固定组40例(治疗组)和跨节段椎弓根螺钉固定组40例(对照组),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行X线及CT检查,测量并比较两组术后Cobb角、矫正率、术后椎管面积改善值、远期丢失率、内固定失效率,同时观察神经恢复情况。结果所有患者获得6～30个月(平均19.5个月)随访。治疗组术后Cobb角、矫正率、术后椎管面积改善值、远期丢失率、内固定失效率方面明显优于对照组(P<0.05);无完全神经损伤者较术前均有1～2级恢复,术后脊髓神经功能无损伤加重,两组比较差异无统计学意义(P>0.05)。结论伤椎置钉内固定术治疗胸腰椎骨折能更好地矫正后凸畸形、重建椎体高度、维持矫正效果和减少内固定的松动断裂等并发症,手术安全且有效。

Comparative Study of the Treatment to Thoracolumbar Fracture between Segmental Posterior Fixation and Cross Segment Pedicle Screw Fixation

Objective To Compare the therapeutic effect between segmental posterior fixation and cross segment pedicle screw fixation for thoracolumbar fracture.Methods Eighty patients with thoracolumbar burst fracture,who were admitted by Chaoyang District Dafeng Hospital of Shantou from January 2010 to June 2012,were randomly divided into the transpedicular screw of three-vertebral fixation group(treatment group of 40 cases) and cross segment pedicle screw fixation group(control group of 40 cases);the treatment group underwent vertebral and vertebral body upper and lower segment pedicle screw fixation,and the control group received traditional four-screw fixation.X-ray and CT examination of all patients before and after operation were done,measuring and comparing the Cobb angle,postoperative correction rate,the canal area improvement,long-term loss rate,the failure rate of internal fixation,and observing the nerve recovery of the two groups.Results All patients were followed up for 6-30 month(19.5 month on average).The Cobb angle,correction rate,improve the postoperative value of vertebral canal area,long-term loss rate,the failure rate of internal fixation of the treatment group were superior to the control group after operation,with significant difference(P < 0.05).The patients without total nerve injury were all 1-2 level lighter than before surgery,its postoperative spinal nerve function had no damage aggravation.The difference between the two groups was not statistically significant(P > 0.05).Conclusion Pedicle screw fixation can better correct the kyphosis,reconstruct vertebral height,maintain correction effect and reduce complications such as loosening or breaking in treatment of thoracolumbar fracture,which is safe and effective.