后入路椎弓根钉不同节段固定治疗重度胸腰段脊柱骨折的临床观察

目的:观察后路椎弓根钉不同节段固定术治疗重度胸腰段脊柱骨折的疗效。方法:选择2016年行后入路椎弓根钉内固定术治疗的重度胸腰段脊柱骨折病人127例，根据固定节段不同分为短节段组（67例）、长节段组（35例）和伤椎节段组（25例）；观察各组手术一般情况；术后随访1~2年，比较各组治疗效果。结果:手术时间和术中出血量为长节段组 > 伤椎节段组 > 短节段组（P<0.01）；术后卧床时间短节段组 > 伤椎节段组 > 长节段组（P<0.01）；术后伤椎前缘高度百分比和Cobb角恢复情况长节段组和伤椎节段组差异无统计学意义（P>0.05），但均优于短节段组（P<0.01）；3组病人Oswestry功能障碍指数问卷表评分组间比较差异均无统计学意义（P>0.05）；3组病人均未发生严重不良情况。结论:短节段固定手术时间短，术中出血量少，而长节段及经伤椎短节段固定在复位及确保伤椎前缘高度方面优势更明显。

Clinical effect of the posterior pedicle fixation of different segments in the treatment of severe thoracolumbar spine fractures

Objective: To explore the clinical effects of the posterior pedicle fixation of different segments in the treatment of severe thoracolumbar spine fractures.Methods: One hundred and twenty-seven severe thoracolumbar spine fractures patients treated with posterior pedicle fixation in 2016 were divided into the short segment group(67 cases),long segment group(35 cases),and injured vertebral segment group(25 cases) according to the different fixed segments.The operation situation in three groups were observed.Three groups were followed up for 1 to 2 years,and the clinical effects among three groups were compared.Results: The operation time and intraoperative blood loss in long segment group,injured vertebral segment group and short segment group gradually decreased(P<0.01),and the postoperative bed time in short segment group,injured vertebral segment group and long segment group gradually decreased(P<0.01).The differences of the postoperative anterior border height percentage of injured vertebrae and recovery of Cobb angle between long segment group and injured vertebral segment group were not statistically significant(P>0.05),and which was better than that in short segment group(P<0.01).The differences of the Oswestry Dability Index scores among three groups were not statistically significant(P>0.05).No serious adverse reaction occurred in three groups.Conclusions: The short segment fixation treatment has shorter operation time,and little intraoperative blood loss.The advantage of long segment fixation and the injured vertebral short segment fixation in the reset and ensuring the injured vertebral anterior edge height are more obvious.