经伤椎固定与经伤椎植骨在治疗胸腰段爆裂骨折的病例对照研究

Case control study on injured vertebra pedicle instrumentation and injured vertebra bone grafting for the treatment of thoracolumbar fractures

目的:比较经伤椎固定与经伤椎植骨治疗胸腰段单节段爆裂骨折的临床疗效。方法:对2008年8月至2010年8月收治的48例胸腰段单节段爆裂骨折患者(均为A3型)进行回顾性分析,其中24例采用短节段固定联合伤椎椎弓根螺钉固定(A组),24例采用短节段固定联合伤椎椎体植骨(B组)。A组中男14例,女10例,平均年龄(44.0±7.4)岁(34～56岁);B组中男13例,女11例,平均年龄(42.5±7.1)岁(31～54岁)。比较两组术前和术后相关影像学参数及手术时间、出血量、并发症。结果:两组患者的性别、年龄、损伤部位、手术出血差异无统计学意义。手术时间A组少于B组。两组患者术后即刻椎体高度、后凸角均明显恢复;术后3个月与术后即刻比较,A组椎体高度、后凸角无明显丢失,但B组椎体高度、后凸角有明显丢失;术后1年与术后3个月比较,两组椎体高度、后凸角无进一步丢失。A组手术失败率小于B组。结论:对胸腰段单一爆裂骨折,经伤椎椎弓根固定手术时间少,比经伤椎植骨更有利于维持术后伤椎高度和矢状位排列,值得推广应用。

Objective ：To compare the clinical effects of injured vertebra pedicle instrumentation and injured vertebra bone grafting in treating thoracolumbar fractures, nethods：A retrospective study was performed on 48 patients with single tboracolumbar fractures （type A3） from August 2008 to August 2010. Twenty-four patients were treated with injured vertebra pedicle instrumentation （group A） and 24 were treated with injured vertebra bone grafting （group B）. There were 14 males and 10 females with an average age of （44.0±7.4） years old （34 to 56） in group A and there were 13 males and 11 females with an average age of （42.5±7.1） years （ranged, 31 to 54） in group B. Operation time, volume of blood loss, complications and the relative parameter of imageology were compared between two groups. Results：There was no significant difference in gender, age, position of injury,volume of blood loss between two groups. Operation time of group A was shorter than that of group B. Cobb angle and injured vertebral height obviously improved at the immediately postoperatively between two groups;there was no sig- nificant difference in group A between the immediately and three months postoperatively, but there was significant difference in group B ; there was no significant difference between three months and one year postoperatively in two groups. The failure rate of group B was significantly higher than that of group A. Conclusion： Pedicle screw fixation in the injured vertebrae has advan- tage of short operation time, can obtain satisfactory effects and is better than injured vertebra bone grafting in maintaining the reduction in treating single thoracolumbar fractures.