伤椎固定结合硫酸钙椎体成形与单纯伤椎固定治疗胸腰椎爆裂骨折的对比研究

Comparison between vertebra fracture fixation plus calcium sulfate cement vertebroplasty and simple fracture fixation for treatment of thoracolumbar burst fractures

目的对比伤椎固定结合硫酸钙椎体成形术与单纯伤椎固定治疗胸腰椎爆裂骨折的临床疗效。方法2005年1月-2008年10月对61例胸腰椎爆裂骨折患者分别采用伤椎固定结合硫酸钙椎体成形（A组）与单纯伤椎固定（B组）进行治疗。A组32例，其中男22例，女10例；年龄21—65岁，平均36．8岁。术后随访13—27个月，平均15．6个月。B组29例，其中男18例，女11例；年龄19—70岁，平均38．3岁。术后随访12～28个月，平均14．7个月。对比两组术前、术后及末次随访时Cobb角、伤椎前缘高度比值和视觉模拟疼痛评分（VAS）。结果两组患者在年龄、性别、损伤节段和术前神经功能方面差异无统计学意义（P〉0．05）。随访中有神经功能损害的患者Frankel分级均有1～2级恢复。B组手术时间和术中出血比A组少（P〈0．05）。两组椎体前缘高度、Cobb角在术前、术后比较差异无统计学意义（P〉0．05），但在末次随访时比较差异有统计学意义（P〈0．05）。末次随访时两组VAS评分差异无统计学意义（P〉0．05）。B组1例螺钉断裂，A组无内固定失败患者。结论与单纯伤椎固定比较，伤椎固定结合硫酸钙椎体成形治疗胸腰椎爆裂骨折能够有效恢复并维持伤椎的高度，提供了伤椎前中柱支撑和固定，疗效较好。

Objective To compare the clinical outcome between vertebra fracture fixation plus injectable calcium sulfate vertebroplasty and simple vertebra fracture fixation in the treatment of thoracolumbar burst fracture. Methods A total of 61 patients with thoracolumbar burst fracture treated from January 2005 to December 2008 were involved and divided into two groups, ie, Group A （ treated with three-level fixation at fractured vertebra and injectable calcium sulfate vertebroplasty） and Group B （treated with three-level fixation at fractured vertebra alone）. Group A had 22 males and 10 females, at mean age of 36.8 years （21-65 years）. The mean follow-up period was 15.6 months （ 13-27 months）. Group B had 18 males and 11 females, at mean age of 38.3 years （19-70 years）. The mean follow-up period was 14.7 months （12-28 months）. The ratio of anterior vertebral height, Cobb angle, VAS score were compared between the two groups. Results There were no statistical differences in the aspects of age, sex, fracture segments and preoperative neurological status distribution in the two groups（P 〉0.05 ）. All patients with partial neurologic deficits initially impro＇~ed for 1-2 grade at the final follow-up. Blood loss and operation time in Group A were less than that in Group B （ P 〈 0.05）. The ratio of anterior vertebral height and the Cobb angle showed no statistical significance （P 〉 O. 05 ）, but the ratio of anterior verte- bral height and the Cobb angle in Group A was less than those in Group B at the latest follow-up （P 〈 0.05 ）. The VAS score showed no statistical significance between the two groups at the latest follow- up （P 〉 0.05）. There was one patient with screw breakage in Group B, while there was no implant failure in Group A. Conclusion The vertebra fracture fixation plus calcium sulfate cement vertebroplasty is a safe and effective method for the treatment of thoraeolumbar burst fracture as it can restore the vertebral mechanical strength, achieve and maintain kyphosis correction, decrease the instrument failure rate and loss of vertebral height.