后路固定非融合术治疗胸腰椎骨折的临床研究

目的:评估后路固定非融合术治疗胸腰段及腰椎骨折的临床疗效,研究其对矢状位力线改变及运动节段保留的影响。方法:25例40岁以下胸腰段和腰椎骨折患者,以两种不同手术治疗方式分为2组:第一组(非融合组)12例,行后路椎弓根内固定非融合治疗;第二组(融合组)13例,行后路椎弓根内固定融合治疗。所有25例患者均在骨折内固定术后约第12个月拆除内固定,最后随访患者6个月余,然后通过术前、术后、内固定拆除前、内固定拆除后及最后随访的影像学评估两组患者固定节段矢状位序列、骨折椎体的高度及非融合组患者前屈后伸活动范围、左右侧屈的范围,另外临床方面,患者主观感受也被评估。结果:在最后的随访中,两组患者骨折椎体的高度能很好的保持,但融合组骨折椎体高度丢失明显好于非融合组,有统计学意义(P=0.047)。非融合组和融合组手术矫正的角度分别为13.5°和16.5°,两者在矫正角度上无统计学差异(P=0.195)。18个月内非融合组和融合组后凸丢失分别为6.9°和5.9°,两组在后凸丢失无统计学差异(P=0.392)。最后随访时平均节段运动矢状面上为14.2,冠状面上为13.1,大多数患者对其外观和功能结果满意。结论:非融合的固定方式治疗胸腰椎骨折可以获得满意的矢状位排列并可以保留固定节段的运动,此研究表面这种非融合的固定方式是一种有效治疗胸腰椎骨折的方法,但更适用于年轻的患者。

Transpedicular Internal Fixation and Nonfusion Method in Thoracolumbar and Lumbar Spinal Fractures

Objective:To evaluate the results of posterior stabilization of thoracolumbar fracture using nonfusion method followed by the removal of metal implants within an appropriate period.Changes in the sagittal alignment and the restoration of segmental motion were also investigated.Methods:Twenty-five patients under 40 years of age with thoracolumbar or lumbar spine fractures were divided into two groups.The first group(Nonfusion group):12 patients received the treatment of transpedicular internal fixation and nonfusion method;The second group(Fusion group):13 patients received the treatment of transpedicular internal fixation and fusion method.All 25 patients removed implants at about 12 months after initial fracture fixation,later patients were observed for more than 6 months.Sagittal alignments of metal fixed segments,heights of vertebral bodies,recovered motion ranges in flexion/extension,right-left bending view were measured radiologically.Clinical aspects,such as gross deformities and functional abilities,were also investigated.Results:Heights of fractured bodies were well maintained at final follow-up in two groups,but the fusion method is superior to the nonfusion method in preventing the loss of the fractured height,it is statistically signifcant(P=0.047);In the two groups the correction angle were 13.5°and 16.5°,it was not statistically signifcant(P=0.195);the loss of correction were 6.9°and 5.9°at a mean 18 months after initial fracture,it was not statistically significant(P=0.392);segmental motion was good in the sagittal plane and in the coronal plane at final follow-up in the nonfusion group.Most patients were satisfied with final gross appearance and functional outcome.Conclusion:The described nonfusion method appears to be effective in achieving favorable sagittal alignment and regaining motions of fixed segments.The present study suggests that the nonfusion method is one of the most effective methods for managing thoracolumbar fractures,especially in young patients.