两种不同复位固定方式治疗胸腰椎爆裂骨折临床疗效比较

The therapeutic effect comparison with two diffent reduction and fixation modus in surgical treatment of thoracolumbar burst fracture

目的比较经伤椎与跨伤椎椎弓根复位固定方式治疗胸腰椎爆裂骨折的临床疗效。方法 2001年6月至2009年3月,共收治无神经损伤的胸腰椎单椎体爆裂性骨折79例,按不同复位固定方式分为A、B两组,A组41例为2006年1月至2009年3月采用经伤椎椎弓根复位固定,其中男22例,女19例;平均年龄38.7岁,伤椎平均高度48.3%,后凸角平均28.8°。B组38例为2001年6月至2006年1月采用跨伤椎椎弓根复位固定,其中男25例,女13例;平均年龄37.6岁,伤椎平均高度49.1%,后凸角平均27.6°。结果 A组术后伤椎高度恢复至平均96.2%,后凸角矫正至前凸角平均5.8°,35例获得随访,随访时间8～35个月,平均25.6月,最后一次随访时伤椎高度平均为94.6%,前凸角平均为5.3°;B组术后伤椎高度恢复至平均90.7%,后凸角矫正至前凸角平均2.4°,31例获得随访,随访时间13～56个月,平均27.8月,最后一次随访时伤椎高度平均为85.4%,前凸角平均为0.3°。结论经伤椎椎弓复位固定治疗胸腰椎骨折,能够恢复和维持伤椎高度和脊柱生理曲度,临床疗效优于跨伤椎复位固定。

Objective To compare the therapeutic effect of undergoing injured vertebral pedicle reduction and fixation with bestriding injured vertebral pedicle in surgical treatment of thoracolumbar burst fractures.Methods 79 cases of single thoracolumbar burst fractures without nerve injured were treated in our hospital from Jun.2001 to Mar 2009,All patients were dedived into A and B two groups.According to diffent reduction and fixation modus,A group involved 41 patients were treated with undergoing injured vertebral pedicle reduction from Jan.2006 to Mar 2009,among the total,22 males and 19 females,the average age was 38.7 years old.The preoperative ratio of the height of the anterior border was 48.3%and kyphosis degree was 28.8°on average.B group involved 38 patients were treated with bestriding injured vertebral pedicle reduction from Jun.2001 to Jan 2006,among the total,25 males and 13 females,the average age was 37.6 years old,The preoperative ratio of the height of the anterior border was 49.1% and kyphosis degree was 27.6°on average.Results The postoperative ratio of the height of the anterior border was 96.2%and the kyphosis was corrected to 5.8°lordosis postoperatively in A group.35 cases were followed up from 8 months to 35 months,average 25.6 months.At the last followed-up time.The ratio of the height of the anterior border was 94.6% and the lordosis was 5.3°.The postoperative ratio of the height of the anterior border was 90.7%and the kyphosis was corrected to 2.4°lordosis postoperatively in B group,31 cases were followed up from 13 months to 56 months,average 27.8 months.At the last followed-up time.The ratio of the height of the anterior border was 85.4% and the lordosis was 0.3°.Conclusion The treatment of thoracolumbar burst fracture with injured vertebral pedicle screw reduction and fixation can regain and maintain the height of injured vertebrae and the physiological curvature of vertebral column,the therapeutic is superior to the modus of bestriding injured vertebral pedicle screw reduction and fixation.