经伤椎与跨伤椎后路短节段内固定治疗胸腰椎爆裂骨折的对比研究

目的对比研究经伤椎与跨伤椎后路短节段内固定治疗胸腰椎爆裂骨折的效果。方法对自2008-06—2012-06收治的58例胸腰椎单一椎体爆裂骨折进行前瞻性对照研究,将患者随机分为2组,其中经伤椎椎弓根钉固定组（A组）,男19例,女11例,平均42.5（30-60）岁;跨伤椎椎弓根钉固定组（B组）,男18例,女10例,平均41.9（28-59）岁。观察比较2组伤椎前缘高度比、矢状面Cobb角、伤椎椎管面积比、神经功能恢复情况、疼痛视觉模拟评分（VAS）及Oswestry功能障碍指数（ODI）等指标。结果术后随访18-60个月,平均30个月。在术后伤椎前缘高度比恢复、伤椎椎管面积比恢复、神经功能恢复及ODI评分方面2组间比较差异无统计学意义（P〉0.05）,但2组在术后Cobb角矫正度、术后1年伤椎前缘高度比和Cobb角矫正丢失程度及末次随访时VAS评分方面差异均有统计学意义（P〈0.05）,A组优于B组。结论经伤椎椎弓根钉复位固定治疗胸腰椎爆裂骨折可提高复位质量,并且能增加后路短节段内固定系统的稳定性,较好地维持复位效果。

Clinical comparative study of short-segment fixation for thoracolumbar burst fractures via or not via injured vertebra

Objective To compare the clinical eurative effect of short-segment fixation via or not via the injured vertebra in treatment of thoraeolumbar burst fractures. Methods A randomized controlled study was performed on 58 patients with single thoracolumbar burst fractures admitted from June 2008 to June 2012. Thirty patients were treated via the injured vertebra fixation （group A） and 28 across vertebral fixation （group B）. Group A included 19 males and 11 females, aged average 42.5 years （30-60 years）. Group B included 18 males and 10 females, aged average 41.9 years （28-59 years）. The height ratio of anterior vertebral fractures, the sagittal Cobb angle, the blockage area of vertebral canal, the conditions of neurological functional recovery. VAS and ODI were measured and compared between two groups. Results All the patients were followed up for an average period 30 months （range;18-60 months）. After operation, there were no significant differences between the two groups regarding the height ratio of anterior vertebral fractures, the blockage area of vertebral canal, the conditions of neurological functional recovery, and ODI of the latest follow-up（P 〉0.05）, but there were significant differences between the two groups in the correction of the sagittal Cobb angle, the loss of correction （12 months after surgery） and the VAS （the final follow-up）（P 〈0.05）, the group A had a better outcome. Conclusion Fixing the pediele screws into injured vertebra would improve the quality of reduction, result in a segmental construct that may improve biomechanieal stability and maintain reduction effect better.