短节段金属植入物固定并经椎弓根植骨治疗胸腰段单节段骨折27例:随访效果评价

Evaluating the clinical efficacy of short-segment pedicle screws fixation for single segmental thoracolumbar fracture in 27 cases

背景：对于青壮年和高龄单节段胸腰段骨折采用后路手术的患者,到底采用长节段还是短节段椎弓根螺钉系统固定更为理想,目前国内外文献并没有一致的意见。目的：评价胸腰段单节段骨折短节段金属植入物固定并经椎弓根植骨的治疗效果。方法：选择2005-06/2008-06收治的资料完整并得到随访的胸腰段单节段骨折患者27例,所有患者骨折位置在T11-L2,椎体A型骨折,无严重神经功能障碍。按照年龄分为2两组,青壮年组12例,随访时间平均28.7个月;高龄组15例,随访时间平均31.4个月。采用胸腰段后路经椎弓根植骨及椎弓根螺钉系统内固定治疗,按照固定范围分为长节段固定和短节段固定。比较两组患者手术时间、出血量、并发症及固定前、固定后1周内、固定后1年后骨折椎体高度及骨折节段后凸角度变化。结果与结论：所有患者固定治疗后脊柱后凸角度均得到明显矫正,骨折椎体高度得到明显恢复。1年随访时,两组采用短节段固定者均发生一定程度的矫正角度丢失,但两组之间差异无显著性意义（P〉0.05）。在青壮年组虽然长、短节段固定患者之间存在不同程度的矫正角度丢失,但差异无显著性意义（P〉0.05）;在高龄组采用长节段固定患者的矫正角度丢失程度低于短节段固定（P〈0.05）。提示青壮年单节段胸腰段骨折患者短节段金属植入物固定并后路经椎弓根植骨疗效满意,高龄患者选择经椎弓根植骨结合长节段固定疗效更为理想。

BACKGROUND：Considerable debate exists whether long-or short-segment pedicle screws fixation is profitable for single segmental thoracolumbar fracture patients. OBJECTIVE：To evaluate the clinical efficacy of segment pedicle screws fixation for single segmental thoracolumbar fracture. METHODS：Totally 27 patients suffered from single thoracolumbar fracture from June 2005 to June 2008 were selected,and the fracture vertebral was between T11 and L2.All patients were divided into 2 groups according to young or older.Young group comprised 12 cases,with mean follow up time of 28.7 months.Elder group consisted of 15 cases,with mean follow up time of 31.4 months.Pedicle screws were inserted in the pedicles of above and lower adjacent vertebral body of injured vertebral body.The operation time,volume of loss blood,complications,the compression vertebral height and kyphosis angle of the fracture vertebral prior to,1 month and 1 year after fixation were compared between 2 groups. RESULTS AND CONCLUSION：The kyphosis angles of all patients were obvious corrected,and the compression vertebral height was notably recovered after treatment.At 1 year of follow up,kyphosis angle was some loss in patients using short-segments pedicle screw fixation in two groups,but the difference had no significance（P 0.05）.There was some loss of kyphosis correction rate in patients received long-or short-segments pedicle screw fixation in the young group,and the difference had no significance（P 0.05）.In addition,in the elder group,compared with patients received short-segments pedicle screw fixation,the loss of kyphosis correction rate was smaller in patients received long-segment pedicle screw fixation（P 0.05）.All results suggested that it is better clinical efficacy of short-segments pedicle screws instrument for treating young thoracolumbar fracture,and long-segments pedicle screws are suitable for elder patients.