经伤椎短钉置钉后路复位内固定治疗单节段压缩性胸腰椎骨折

目的：探讨后路经椎弓根伤椎短钉置钉复位短节段内固定治疗单节段压缩型胸腰椎骨折的有效性和安全性。 方法：回顾性分析2010年1月～2012年1月间我院手术的单节段压缩型型胸腰椎单节段骨折患者共87例。测量手术前后，术后，术后1年随访数字射线摄影(DR)侧位片上的伤椎上下椎体Cobb角、伤椎椎体前缘高度(前高)，计算伤椎前高压缩比；统计手术时间和术中血量，观察手术并发症，评估患者术后疼痛。结果：共73例患者获得随访，其中A组38例，B组35例。术前两组年龄，伤椎前高压缩比，Cobb角无明显差异。两组手术时间，术后及末次随访椎体前高压缩比和 Cobb角比较差异有显著性(P<0．05)，手术出血量， 疼痛评分上．两组比较差异无显著性(P>0．05)。结论：后路经椎弓根伤椎短钉置复位短节段内固定治疗单节段压缩型胸腰椎骨折能安全有效地重建椎体高度、矫正脊柱后凸畸形。

Posterior reduction and short pedicle screw fixation at fracture level for treatment of single level compress thoracolumbar fractures

Objective To assess the efficacy and safety of posterior reduction and short pedicle screw fixation at fracture level (method A) for treatment of single level compress thoracolumbar fractures. Methods The clinical data of 87 patients with single level compress thoracolumbar fractures, who were surgically treated between January 2010 and January 2012 in our hospital, were retrospectively analyzed. treated by posterior. The patients were divided into two groups according to surgical methods. Group A: Patients were treated with method A; Group B: Patients were treated by conventional posterior decompression, redultion of fracture and short segment fusion and internal fixation. The operation time and intraoperative blood loss were recorded and the postoperative pain was evaluated. The adjacent vertebral Cobb angle and the anterior height of the injured vertebra on the lateral radiographs were measured before surgery, immediately after surgery, and 1 year after surgery, and the vertebral compression ratio was calculated. Results Among the 73 patients who were finally included in the study, 38 were in group A and 35 in group B. There were no significant differences in patient age, compression ratio, Cobb angle before or after surgery between the two groups. The operation time in group A was signficantly longer than that in group B(121 min vs 92 min,P<0.05); the compression ratios immediately and 1 year after surgery in group A were significantly higher than those in group B (immediately after surgery: 91.3% (82%-93%) vs 77.2% (73%-86%), P<0.05; 1 year after sugtery: 87.2% (79%-93%) vs 73.1%(68%-80%),P<0.05]). The Cobb angle at 1 year after operation in group A was significantly smaller than that in group B (7.8°0°-15°] vs 11°2°-17°],P<0.05). There was no significant differences in blood loss or scores of low back pain between the two groups. Conclusion Posterior reduction and short pedicle screw fixation can safely and effectively reconstruct the vertebral body height and correct kyphosis in patients with single level compress thoracolumbar fractures.