短节段伤椎内固定技术治疗胸腰段椎体骨折的临床疗效观察

目的评价短节段伤椎内固定技术在治疗胸腰段单椎体骨折中的临床效果。方法选取本院2004年7月至2008年5月胸腰椎骨折患者48例,其中男31例,女17例;年龄23⁵5岁,平均39岁,所有病例CT显示均有椎管内占位,其中16例有不同程度的下肢症状。随机分为试验组和对照组。其中试验组33例(男22例,女11例),行短节段内固定技术固定骨折椎体,对照组15例(男9例,女6例),行单节段四钉两棒内固定技术固定骨折椎体,所有患者均得到随访,以伤椎前缘压缩程度、Cobb's角及中柱突入椎管的程度为指标来评价两组的手术效果,所有病例均随访至术后1年。结果试验组无论在术后1周的即时复位还是术后1年复位丢失上都要优于对照组,两者相比有统计学意义(P<0.01)。结论短节段伤椎内固定技术治疗胸腰段椎体骨折无论在骨折复位还是维持术后复位丢失方面都要优于单节段四钉两棒内固定方式,而且短节段伤椎内固定技术也较少发生内固定物折断、折弯及椎弓根钉松动、拔出等内固定失败情况。

Clinical effect of three vertebral body and double segments fixation in creating thoracolumbar ;fracture

Objective To evaluate the clinical effect of posterior short segment and fractured vertebra fixation in creating thoracolumbar fracture. Methods 48 patients with thoracolumbar spine fracture were included of our hospital between July 2004 and May 2008, 33 patients were men, 17 patients were women, range of age was from 23 to 55, average was 39. CT displays that all patients had outstanding in vertebral canal, and there were 16 patients having different lower limb symptom,dividing them into experimental group and control group at random. There were 33 patients （man 22, woman 11） in experimental group underwent internal fixation of short segment and fractured vertebra, and control group was 15 patients（man 9, woman 6） underwent posterior monosegment fixation. All cases were followed-up for one year. To assess the clinical effect of two group by compression degree of anterior border of fractural vertebral body, cobb＇s angle and the degree of outstanding. Results Experimental group was better than control group not only in immediately reset behind one week but also the lost of reset behind one year, the difference had statistical significance（P〈0.01）. Conclusion Short segment and fractured vertebra fixation is better in creating thoracolumbar spine fracture than posterior monosegment fixation not only in immediately reset but also the lost of reset, and the former has less risk, for instance the break of internal instrument and the pulling out of vertebral arch pedical nail.