短节段椎弓根钉固定手术治疗脊柱骨折的效果及对患者脊髓功能影响情况研究

Short segment pedicle screw fixation for spinal fractures and its effect on spinal cord function

目的探讨短节段椎弓根钉固定手术治疗脊柱骨折患者的临床效果及对脊髓神经功能的影响。方法对147例胸腰椎骨折患者(2005年6月—2015年6月)进行回顾性分析,根据手术方法分为经伤椎组77例(经伤椎短节段椎弓根螺钉固定治疗)、跨伤椎组70例(跨伤椎椎弓根螺钉固定治疗),对比两种方式的手术时间、失血量、切口长度、Cobb角、美国脊柱损伤协会(ASIA)脊髓神经功能分级等指标。结果经伤椎组患者的手术时间、失血量、切口长度均显著高于跨伤椎组,差异有统计学意义(P<0.05);术前、术后1周、末次随访时,两组患者的伤椎前缘高度比比较,差异无统计学意义(P>0.05),两组术后1周、末次随访时的伤椎前缘高度比较术前均显著提高(P<0.05);术前、术后1周,两组患者Cobb角比较,差异均无统计学意义(P>0.05),末次随访时,经伤椎组Cobb角大于跨伤椎组,差异有统计学意义(P<0.05),术后1周、末次随访时,两组患者的Cobb角较术前均显著降低(P<0.05);末次随访时,两组患者的ASIA分级较术前均显著改善(P<0.05)。结论经伤椎短节段椎弓根固定手术治疗脊柱骨折患者效果较好,但是相对于跨伤椎椎弓根螺钉固定不具有临床优势。

Objective To investigate the clinical effect of short segment pedicle screw fixation in the treatment of spinal fractures and its influence on the spinal nerve function. Methods Totally 147 patients with thoracolumbar fractures（ from Jun. 2005 to Jun. 2015） were analyzed retrospectively. According to the surgical method,patients were divided into trans-vertebral group（ 70 cases,trans-vertebral pedicle screw fixation）,and cross-vertebral group（ 77 cases,cross-vertebral pedicle screw fixation）. The operative time,blood loss,incision length,Cobb angle,and ASIA spinal neurological functional grading were compared between the two surgical procedures. Results The operative time,blood loss,incision length in the cross-vertebral group were significantly higher than those in the trans-vertebral group,and the difference was statistically significant（ P〈0. 05）. At the time of preoperative,postoperative 1 week,and last follow-up,there was no statistically significant difference in the height ratio of the injured vertebra between the two groups（ P〉0. 05）. The height of the frontal injured vertebra was significantly higher in both groups at 1 week postoperatively and at the last follow-up（ P〈0. 05）. There was no significant difference in Cobb angle between the two groups before operation and at postoperative 1 week（ P〉0. 05）. At the last follow-up,the Cobb angle in the cross-vertebral group was higher than in the trans-vertebral group,and the difference was statistically significant（ P〈0. 05）. At 1 week postoperatively and at the last follow-up,Cobb angle was significantly lower in both groups than before surgery（ P〈0. 05）. At the last follow-up,ASIA grades in both groups improved significantly（ P〈0. 05）. Conclusion Short-segment cross-vertebral pedicle screw fixation is effective in the treatment of spinal fractures,but it has no clinical advantages over trans-vertebral pedicle screw fixation.