后路短节段椎弓根内固定结合间接复位法在胸腰椎爆裂性骨折中的疗效观察及其影响因素分析

Observation on the Clinical Efficacy and its Influencing Factor of Posterior Short Segment Pedicle Screw Fixation Combined with Indirect Reduction on Thoracolumbar Burst Fractures

目的:评价后路短节段椎弓根内固定结合间接复位法对胸腰椎爆裂性骨折的疗效及其影响因素,为临床治疗提供参考。方法:通过对2000年6月～2011年3月112例胸腰椎爆裂性骨折接受后路短节段椎弓根内固定治疗的患者,分别对其术前、术后、末次随访拍摄正侧位片,手术前后拍摄CT。X线片上测量伤椎前后缘高度比(AVH、PVH),楔变角(VBA),Cobb's角及矢状面指数(SI);CT片上测量骨块所占椎管矢状径比例并计算骨块回缩率。根据Denis疼痛分级及Oswestry功能评分和Frankel分级对手术前后及末次随访情况进行评估。结果:112例患者VBA、Cobb's角术前、术后及末次随访的结果分别是:VBA:19.4°±7.7°,4.2°±4.7°,6.7°±5.0°;Cobb's角:17.8°±9.3°,2.8°±8.7°,8.8°±8.5°;SI值:16.3°±8.7°,1.9°±4.3°,6.0°±7.1°,术后及末次随访时伤椎AVH、PVH均较术前显著增加,VBA、Cobb?s角及SI均较术前显著减少,差异均有统计学意义(P<0.05),且术后与末次随访时各项指标均有不同程度的丢失。末次随访时,仍有2例患者存在括约肌障碍,1例全瘫患者无明显恢复,其余患者均有Frankel 1级以上的改善;Oswestry功能障碍评分优82例,良20例,差3例,优良率为97.1%,平均得分11±14,其中有4例发生内固定物断裂。Denis疼痛分级结果为:P1级61例,P2级40例,P3级10例,P4级1例。椎管中骨块复位率与术后AVH复位值成正相关(P<0.01),与术后VBA负相关(P<0.05)。结论:后路短节段椎弓根内固定间接复位治疗胸腰椎爆裂性骨折是一种安全有效的方法,临床疗效可靠。

Objective： To evaluate the clinical efficacy and its influencing factors of posterior short segment pedicle screw fixation combined with indirect reduction on thoracolumbar burst fractures and provides reference for clinical treatment, Methods： From June 2008 to March 2011, 112 patients with thoracohunbar burst fractures were involved in this study. All of the patients were checked with X-rays pre-and post-operation and last follow-up. Some of them were checked with CT. Anterior and posterior vertebral height （AVH, PVH）, Vertebral body angle （VBA）, Cobb angle and sagittal index （SI） were evaluated through x-rays. Bone occupied the spinal canal sagittal diameter ratio were measured on the CT scan. The clinical results were assessed by Frankel Scales, Denis Pain Scale and Oswestry Disability Index. Results： All patients were followed up. The VBA, Cobb Angel and SI all showed significant differences compared with the angle before surgery （P〈0.05）. The changes of angle at different stages were as follows： VBA：19.4°±7.7°,4.2°±4.7°,6.7°±5.0°; Cobb＇s Angel：17.8°±9.3°,2.8°±8.7°,8.8°±8.5°; SI values reduced from 16.3°±8.7°,1.9°±4.3, the last follow-up was 6.0°±7.1°. The AVH and PVH postoperation and in last follow-up were both significantly higher than those preoperation, while VBA, Cobb＇s Angel and SI postoperation and in last follow-up were all significantly lower than those preoperation （P〈0.05）. The neurological status of all patients improved at least 1 Frankel grade except two patients still suffering sphincter disturbances and one patient had no significant recovery with complete paraplysis. Oswestry disability scores were excellent in 82 cases, good in 20 cases and poor in 3 cases. The average score was 11±14. According to the Denis Pain Scale, 61 cases were P1, 40 cases were P2, 10 cases were P3, and 1 case was PI. The rate of reduction was positively correlated with postoperative AVH （P〈0.01）, and negatively correlated with postoperative VBA （P〈0.05）. Conclusion： The posterior short segment pedicle screw fixation combined with indirect reduction is a safe and effective method for thoracolumbar burst fractures.