后路经伤椎单节段与双节段固定治疗胸腰段骨折疗效比较

目的比较后路经伤椎单节段与双节段固定治疗胸腰段骨折的临床疗效。方法将70例胸腰段骨折患者根据固定方式不同分为单节段组(采用后路经伤椎单节段固定,33例)和双节段组(采用经伤椎双节段固定,37例)。比较两组患者手术时间、出血量(术中失血量+术后引流量)、住院天数、围手术期并发症、术后24个月ODI、术后伤椎高度矫正率、术后24个月伤椎高度矫正丢失率、术后Cobb角矫正率及术后24个月Cobb角矫正丢失率。结果患者均获得随访,时间24个月。两组患者住院天数、术后并发症发生率、术后伤椎高度矫正率、术后Cobb角矫正率、术后24个月ODI等比较差异均无统计学意义(P0.05);两组患者的手术时间、出血量、术后24个月伤椎高度矫正丢失率、术后24个月Cobb角矫正丢失率比较差异均有统计学意义(P0.05)。结论后路经伤椎单节段与双节段固定治疗胸腰段骨折均能获得满意的临床疗效,单节段固定手术时间及出血量较少,双节段固定够有效恢复并维持椎体高度、减少术后后凸畸形矫正丢失。

Efficacy comparison of treatment of thoracolumbar burst fractures with posterior monoseg-mental or bisegmental pedicle screw

Objective To compare clinical effect and radiographic results of posterior monosegment or bisegmental pedicle screw for thoracolumbar burst fractures. Methods A total of 70 patients were divided into monosegmental group ( posterior monosegmental pedicle screw for thoracolumbar burst fractures, 33 cases) and bisegmental group ( posterior bisegmental pedicle screw for thoracolumbar burst fractures, 37 cases ) , according to different fixation method. These data were compared between two groups, including operative time, blood loss ( intraoperative blood loss + postoperative drainage) , hospital stay, perioperative complications, ODI at 24 months after surgery, postoper-ative vertebral height correction rate, corrected vertebral height loss rate at 24 months after surgery, postoperative Cobb angle correction rate, and Cobb angle correction loss rate at 24 months after surgery. Results All of patients were followed up for 24 months. There was no significant difference between the monosegmental group and bisegmen-tal group in hospital stay, perioperative complications, ODI at 24 months after surgery, postoperative vertebral height correction rate, and postoperative Cobb angle correction rate (P>0. 05). However, there were significant difference between the monosegmental group and bisegmental group in term of operative time, blood loss, corrected vertebral height loss rate at 24 months after surgery, and Cobb angle correction loss rate at 24 months after surgery ( P <0. 05). Conclusions Both of posterior monosegment or bisegmental pedicle screw for treatment of thoracolumbar burst fractures can achieve satisfactory clinical outcomes. The former has a less operative time and blood loss, and the latter is effective to maintain reduction and reduce the rate of correction loss.