经伤椎单节段与跨伤椎短节段固定治疗胸腰椎骨折的临床疗效对比

Comparison of clinical outcomes of mono-segmental internal fixation between through and across injured vertebrae for thoracolumbar fracture

目的比较经伤椎单节段固定与跨伤椎短节段固定治疗胸腰椎骨折的临床疗效。方法回顾性分析2008年8月～2011年8月采用经伤椎单节段(A组)与跨伤椎短节段(B组)椎弓根钉内固定治疗并获12个月以上随访的65例胸腰椎骨折患者,分别在术前、术后3 d和随访末期时测量伤椎以及其上下相邻正常椎体的前缘高度、矢状面Cobb角,观察术后伤椎椎体前缘高度比和矢状面Cobb角改善情况,以及末次随访时的矫正度(包括伤椎高度矫正度和Cobb角矫正度)丢失情况,同时比较2种手术的手术时间、手术出血量。结果有65例患者影像学资料完整且获得了12个月以上的随访,平均随访时间21.6个月(12～46个月)。术后2组患者椎体前缘高度及Cobb角均获得显著恢复,但末次随访时A组对椎体前缘高度和矢状面Cobb角的保持优于B组,差异有统计学意义(P<0.05);2组手术时间和手术出血量之间差异无统计学意义(P<0.05)。结论对于胸腰椎骨折,经伤椎单节段固定术和跨伤椎短节段固定术都能较好的恢复椎体高度和矢状面Cobb角,但经伤椎单节段固定术对术后矫正度的保持优于跨伤椎短节段固定术。

Objective To compare the clinical outcomes of mono-segmental internal fixation between through and across injured vertebrae for thoracolumbar fracture. Methods A total of 65 patients with thoracolumbar burst fracture who were trea- ted by internal fixation through （Group A） or across （Group B） injured vertebrae from August 2008 to August 2011 and fol- lowed up for more than 12 months were involed in this retrospective study. The anterior height of the injured vertebra as well as the adjacent 2 normal vertebrae, and Cobb＇ s angle of the injured vertebra were measured. The compression rate and the loss of correction were calculated at the final follow-up. The operation time and blood loss of the 2 groups were also recorded. Results Sixty-five patients receieved an average of 21.6 months follow-up （12-46 months）. The compression rate and the Cobb＇ s angle were significantly restored after the surgery, but Group A had a better maintainance of correction compared with Group B at the final follow-up（ P 〈 0.05 ）. The difference of blood loss and duration of operation between 2 groups was not sig- nificant（P 〉 0.05 ）. Conclusion For thoracolumbar fractures, mono-segmental internal fixation both through and across injured vertebrae can restore the vertebral height and Cobb＇ s angle well, but mono-segmental internal fixation through injured vertebrae has a better maintainance of correction.