附加经伤椎椎弓根螺钉内固定治疗胸、腰椎骨折的临床评价

Internal fixation of thoracolumbar spine fractures with screws through the pedical of fractured vertebral arch

目的分析和探讨经伤椎椎弓根固定治疗胸、腰椎骨折的可行性及临床疗效。方法回顾性分析我科自2005年1月至2009年2月收治的67例单椎体胸、腰椎骨折患者的临床资料,其中单纯行跨伤椎的4钉固定术(4钉组)45例,附加经伤椎椎弓根固定的6钉固定术(6钉组)22例。随访6～43个月,平均随访12.6个月。对比2组的手术切口长度、术中出血量、手术时间、术后伤口引流量等方面及伤椎前缘高度、伤椎后缘高度、矢状位Cobb角、内固定失败率、术后并发症。结果2组围手术期相关指标,除术后伤口引流量差异有统计学意义(P<0.05),手术切口长度、手术时间、术中出血量、术后住院时间指标差异无统计学意义(P>0.05)。伤椎前、后缘高度、矢状位Cobb's角、伤椎后凸角术后较术前均有明显改善(P<0.05),且6钉组的伤椎前缘、后缘术后高度及随访期间均优于4钉组(P<0.05)。4钉组固定术后过度撑开致术后后凸加重发生率为8.9%,退钉发生率为3.3%,6钉组无上述情况。2组术后神经功能恢复情况没有显著性差异。结论经伤椎椎弓根固定治疗胸、腰椎骨折较传统跨伤椎固定能更好矫正伤椎椎体前、后缘高度且能够较好维持矫正效果,且对患者手术创伤与传统跨伤椎内固定术相当,是切实可行及有效的方法。

Objective To study the feasibility and clinical therapeutic effect of internal fixation of thoracolumbar fractures with screws through the pedicle of fractured vertebral arch. Methods Clinical data about 67 single level thoracolumbar fracture patients admitted to our department from January 2005 to February 2009 were retrospectively analyzed. The patients were divided into 4-screw fixation group （ n = 45 ） and 6-screw fixation group （n = 22）. Simple trans-fractured vertebral fixation was performed for the fractures with 4 screws in 4-screw fixation group, and fractures in 6-screw fixation group were fixed with 6 screws through the pedical of fractured vertebral arch. The patients were followed up for 6 -43 months （mean 12.6 months）. The incision size, intraoperative blood loss, postoperative drainage, anterior and posterior margin height of fractured vertebra, Cobb＇ angle, internal fixation failure, and postoperative complications were compared between the two groups. Results The difference in perioperative parameters, such incision size, intra-operative blood loss, postoperative hospital stay, except for postoperative drainage, was significant between the two groups （P 〈 0. 05 ）. However, no difference was found in postoperative parameters, such incision size, intra-operative blood loss, postoperative hospital stay （P 〉 0. 05）. Compared with before operation, the anterior and posterior margin height of fractured vertebra, Cobb＇ angle, and posterior prominent angle were more significantly improved in 6- screw fixation group than in 4-screw fixation group after operation （P 〈 0. 05 ）. The incidence of exacerbated postoperative posterior prominence was 8.9% in 4-screw fixation group with a crew exit rate of 3.3%. However, no such events occurred in 6-screw fixation group. Conclusion Internal fixation of thoracolumbar fractures with screws through the pedicle of fractured vertebral arch can achieve better outcome in correcting the anterior and posterior margin height of fractured vertebral than traditional trans-fractured vertebral fixation, and is a practical and effective procedure for the fixation of thoracolumbar fractures.