年龄及固定范围对单节段胸腰段A型骨折疗效的影响

Studying the influence of age and short or long segments of pedide screw instrumentation to the clinical efficacy of early single thoracolumbar fracture

目的分析年龄及固定范围对单节段胸腰段A型骨折疗效的影响。方法2005年6月至2008年6月，27例有完整随访资料的单节段胸腰椎骨折患者，AO分型均为A（A1或A2）型，均无严重神经功能障碍；其中T11 3例，T12 7例，L1 11例，L2 6例。所有患者按年龄分为：A组（青壮年组）12例，年龄16～55岁，平均（32．6±10．7）岁；13组（高龄组）15例，年龄56～78岁，平均（66．8±9．2）岁。采用后路经椎弓根椎体内同种异体骨植骨及椎弓根螺钉内固定系统治疗，固定范围分为长节段固定（骨折椎体上、下方相邻各2椎体）和短节段固定（骨折椎体上、下方相邻1椎体）。记录并比较A、B两组不同固定节段患者的手术时间，出血量，术前及术后1周、1年骨折椎体高度及骨折节段后凸角度变化以及并发症等。结果患者均获随访，随访时间10～34个月，平均（29．6±9．1）个月。采用短节段固定者，A、B两组椎体前方压缩比术前分别为（41．3±14．0）％、（38．5±11．2）％，术后1周分别为（5．4±1．0）％、（8．3±2．1）％，术后1年分别为（13．6±1．1）％、（21．4±5．2）％；脊柱后凸角度术前分别为17．5°±1．0°、16．3°±2．1°，术后1周分别为4．2°±1．0°、6．0°±1．1°，术后1年分别为11．5°±1．0°、13．4°±3．0°。采用长节段固定者，A、B两组椎体前方压缩比术前分别为（40．8±11．5）％、（44．3±10．2）％，术后1周分别为（4．6±1．2）％、（9．7±2．1）％，术后1年分别为（8．3±1．0）％、（11．2±3．0）％；脊柱后凸角度术前分别为20．7°±2．0°、16．4°±3．1°，术后1周分别为3．1°±1．0°、8．3°±1．0°，术后1年分别为6．1°±1．0°、11．1°±4．0°。无论长节段固定还是短节段固定，两组患者术前椎体压缩程度及矢状位角度比较，差异均没有统计学意义（P〉0．05）；术后1周及1年时骨折椎体前方高度及骨折节段后凸角度与术前比较，差异均有统计学意义（P〈0．05），而术后1年与1周比较，差异也均有统计学意义（P〈0．05）。结论青壮年单节段胸腰段骨折患者无论采用短节段还是长节段固定手术，治疗效果均满意；对于高龄患者采用长节段固定较短节段固定疗效更为理想。

Objective To study the influence of different age and short or long segments of pedicle screw fixation to the clinical efficacy of early single thoracolumbar fracture. Methods From June 2005 to June 2008, 27 patients of early single thoracolumbar fracture were treated using short or long segments pedicle screw instrumentation, fracture vertebral（AO classification： type A1 or A2 ） was between Tn or L2. All patients were divided into A or B group according to age. A group： 12 cases mean age （32. 6 ± 10. 7） years old （range, 16-55 years old）. B group： 15 cases mean age （66. 8 ± 9. 2） years old （range, 56-78 years old ）. All patients were treated with bony autograft by transpedicular of fracture vertebral and interfixation by pedicle instrumentation. Pedicle screws were inserted in the pedicles of above and lower adjacent vertebral body of fracture vertebral, and others were inserted in the pedicles of above and lower two vertebral bodies of injured vertebral. Recorded operation time, blood loss and occurrence of complications. All patients took X radiograph plane examination （anterior-posterior position and lateral position） before operation and during 1 week of post operation and more than 1 year of follow up. Measured percentage of anterior compression vertebral high and kyphosis angle of the fracture vertebral by the same one group doctors. Results Mean follow up time was （29. 6 ± 9. 1 ） months （ range, 10-34 months）. The patients using short segments pedicle screw fixation in A and B group, mean operation time were （ 102± 16） min and （118 ±24） min （P =0.072）, mean volume of loss blood were （315 ±87） ml and （331 ±87） ml （P = 0. 064） respectively. The patients using long segments pediele screw fixation in A and B group, Mean operation time were （ 138 ± 22 ） min and （ 159 ± 31 ） rain （ P = 0. 052 ） , Mean volume of loss blood were （446 ± 102） ml and （482 ± 148） ml （P =0. 055） respectively. There was no statistic different significantly between A and B group. The patients using short segments fixation, preoperation, during one week of post operation, one year of follow up, in A group the percentage of anterior compression vertebral high were 41.3 ±14.0, 5.4±1.0, 13.6±1.1, and 38.5 ±11.2, 8.3 ±2.1, 21.4 ±5.2 in B group. The patients using long segments fixation, at some time of preoperation, during one week of post operation and one year of follow up the percentage of anterior compression vertebral high were 40. 8 ± 11.5, 4. 6 ± 1.2, 8.3 ± 1.0 in group A, and 44. 3 ± 10. 2, 9. 7 ± 2. 1, 11.2 ± 3.0 in group B. In group A and B the kyphosis angle of fracture segment was 17. 5°± 1. 0°and 16. 3° ±3.1° before operation, 4. 2°±1.0° and 6. 0°± 1.1° in one week of postoperation and 11.5°± 1.0° , 13.4±3.0° in one year later postoperation. All the compression vertebral high was recovered and kyphosis was corrected significantly during one week and one year after operation （P 〈 0. 05 ）, but there was some loss of kyphosis correction rate in follow up. Conclusion There is better clinical efficacy of short segments pedicle instrumentation for treating early thoraeolumbar fracture in the young group, but long segments fixation of pedicle instrumentation is more suitable for the older group.