跨伤椎固定与经伤椎固定治疗胸腰椎骨折对椎体高度及侧弯角度改善的效果比较

Effect comparison of consecutive pedicle screw fixation and short-segment pedicle screw fixation in vertebral body height and scoliosis angle improvement of thoracolumbar fracture

目的 探讨跨伤椎固定与经伤椎固定治疗胸腰椎骨折对椎体高度及侧弯角度改善的效果.方法 选择本院2010年1月～2012年12月收治的63例胸腰椎骨折患者,按治疗方法分为两组,33例采用椎弓根螺钉跨伤椎固定治疗为A组,30例采用经伤椎固定治疗为B组,观察两组术前、术后、随访1年时的Cobb角、椎体前缘高度,随访观察两组患者的植骨融合率、脊髓神经恢复及局部疼痛情况.结果 患者术后随访均满1年,平均14.5个月.术后5d,两组Cobb角、椎体前缘高度比较,差异无统计学意义.随访1年时,两组椎体前缘高度比较差异无统计学意义;两组Cobb角比较,差异有统计学意义;内固定取出后A组Cobb角矫正度丢失更明显.随访显示,A组植骨融合率明显低于B组,差异有统计学意义.术后1年时两组脊髓神经功能恢复差异无统计学意义,但B组局部疼痛方面优于A组.结论 经伤椎固定治疗胸腰椎骨折在植骨融合、脊柱矫正度维持及局部疼痛方面较跨伤椎固定有明显优势,值得应用.

Objective To investigate the effect of consecutive pedicle screw fixation and short-segment pedicle screw fixation in vertebral body height and scoliosis angle improvement of thoracolumbar fracture. Methods 63 patients with thoracolumbar fractures in our hospital from January 2010 to December 2012 were selected and divided into two groups according to the treatment methods,33 cases treated with consecutive pedicle screw fixation were selected as group A,30 cases treated with short-segment pedicle screw fixation were selected as group B,the preoperative,postoper- ative,and Cobb angle 1-year followed--up and vertebral height were observed,the bone graft fusion rate,spinal nerve re- covery and local pain of two groups were observed. Results Patients were followed up for at least 1 year, with an aver- age of 14.5 months.Five days after surgery,Cobb angle and vertebral height of two groups compared,the difference was not statistically significant.After l-year followed-up,vertebral height of two groups was not significantly different （P〉 0.05）,Cobb angle of two groups was significantly different,Cobb angle of group A had more pronounced loss of correc- tion.The follow-up showed fusion rate of group A was significantly lower than that of group B,the difference was statis- tically significant.The spinal cord nerve function recovery of two groups was no significantly different,but local pain of group B was superior to group A. Condusion The injured vertebra fixation for thoracolumbar fractures in the bone graft fusion the spinal correction maintain than cross locahzed pain in the injured vertebra fixed there are obvious advantages worth Application degrees.