充气式脊柱弹性固定牵引器在胸腰椎爆裂骨折后路内固定术后的应用价值

目的：评价充气式脊柱弹性固定牵引器在胸腰椎爆裂骨折后路内固定术后的应用价值。方法：采用非盲前瞻性随机对照方法,将480例年龄在25～45岁,椎体前缘高度丢失率大于50%的外伤性单节段胸腰椎爆裂骨折病人平均分为A组（术后3周佩戴充气支架坐起或下地）、B组（术后3周佩戴普通硬质腰围坐起或下地）、C组（术后8周佩戴充气支架坐起或下地）、D组（术后8周佩戴普通硬质腰围坐起或下地）。采用ALPF复位内固定植骨融合术治疗。术后随访5年。评价⑴术前、术后、内固定取出前、末次随访时,伤椎前、后缘高度、矢状面后凸校正Cobb角;⑵术前和末次随访时神经功能Franlkel分级;⑶末次随访时腰痛Denis分级。结果：（1）A、C两组无钉棒断裂;B组螺钉断裂8例（6.7%）;D组螺钉断裂3例（2.5%）。（2）四组伤椎前、后缘高度和矢状面后凸校正Cobb角术后均恢复良好,与术前相比有非常显著性差异（P〈0.01）,四组间无显著性差异（P〉0.05）。内固定取出前及随访时,B组的伤椎前缘高度丢失较多,矢状面后凸校正Cobb角明显增大（P〈0.05）。而A、C、D三组无明显丢失（P〉0.05）,明显优于B组（P〈0.01）。⑶末次随访时,A、C、D组神经功能均好于B组（P〈0.05）,腰痛程度均较B组轻（P〈0.01）,腰痛程度与矢状面后凸校正Cobb角呈正相关（相关系数为0.305,P〈0.05）。结论：ALPF治疗胸腰椎爆裂骨折可获得满意的复位,但术后缺乏有效的支具保护可影响疗效。术后应用充气式弹性脊柱固定牵引器,可早期下地,并能有效保持复位效果,降低内固定失效率和腰痛程度。

Applied Value of Aerated Elastic Fixation Tractor for Treatment of Thoracolumbar Vertebral Bursting Fracture after Internal Fixation with Posterior Approach

Objective： To evaluate the applied value of the aerated elastic fixation tractor for treatment of thoracolumbar vertebral bursting fracture after internal fixation with posterior approach. Methods.. A nonblinded, prospective and randomized controlled evaluation was performed. Four hundred and eighty patients, aging from 25 years to 45 years, who suffered from single segmental thoracolumbar vertebral bursting fractures with more than 50 % loss of vertebral height at the anterior part, were randomly divided into 4 groups., patients in group A and C used the aerated elastic tractor respectively 3 weeks and 8 weeks after the operation while patients in group t3 and D used ordinary hard waist belt 3 weeks and 8 weeks after the operation, respectively. The ALPF method was applied. All the patients were followed up for 5 years. The evaluation items included the following： （1） The anterior vertebral height, posterior vertebral height and correction of sagittal kyphotic Cobb angle before and after the operation, before the internal fixation being taken out and by the last follow--ups （2） Neurological function by Frankel grade before the operation and by the last follow--ups （3） Lumbago by Denis grade at the last follow up. Results：（1） No broken screws were noted in group A and C while there were 8 cases with screws broken in group B （6.7%） and 3 in group D （2.5%）. （2） The anterior, posterior vertebral height and sagittal kyphotic Cobb angle recovered well after the operation in all groups and there were significant differences compared with before the operation （P（0.01） but no remarkable differences appeared among the 4 groups （P〉0.05）. Before the internal fixation was taken out and by the last follow--up, the loss of injured anterior vertebral height was more obvious and sagittal kyphotic Cobb angle increased notably in group B than in the rest groups （P〈0.01）. No obvious losses were observed in group A, C and D （P〉0.05）, with better outcome as compared to group B