体位复位结合术中器械复位治疗牵张型胸腰段骨折

Treatment of flexion distraction thoracolumbar fractures by postural reduction with instrumental reduction

目的：探讨体位复位结合术中器械复位治疗牵张型胸腰段骨折的临床效果。方法：回顾性研究2009年8月至2011年8月收治的屈曲牵张型胸腰段骨折患者43例，男28例，女15例；年龄34—56岁，平均4J4岁；均采用体位复位结合术中器械复位椎弓根螺钉固定。比较术前、术后1周和术后1年伤椎前缘和后缘的高度、后凸畸形角度；术前和术后1年视觉模拟评分（VAS）；并记录并发症。结果：伤椎后缘高度在术前、术后1周、1年比较差异无统计学意义（P〉0．05）。椎体前缘高度、后凸角在术后1周和术前相比差异有统计学意义（P〈0．05），显著恢复；术后1年与1周比较差异无统计学意义（P〉0．05），无明显丢失。VAS评分由术前的7．2±1．2减少至术后1年的0．8±0．7（t=18，47，P〈0．001）。结论：对屈曲牵张型胸腰段骨折体位复位结合术中器械复位能有效恢复椎体高度、纠正矢状位排列，并能取得良好临床疗效，值得推广应用。

Objective： To study the curative effect of postural reduction with instrumental reduction in treatment of flexion- distraction thoracolumbar fractures, nethods：A retrospective study was performed on 43 patients with single thoracolumbar flexion-distraction fractures admitted from August 2009 to August 2011, included 28 males and 15 females with an average age of 44 years old （34 to 56 years old）. All patients were treated with postural reduction with instrumental reduction. The kyphosis （Cobb angle）, recovery of injured vertebral height and complication were analyzed. The visual analogue scale （VAS） and com- plications were followed up and recorded. Results：There was no difference in recovery of injured vertebral posterior height a- mong preoperative, 1 week and 1 year after operation （P〉0.05）. There were significantly difference in kyphosis （Cobb angle） and recovery of injured vertebral anterior height between preoperative and postoperative at 1 week （P〈0.05）. There was no dif- ference in kyphosis （Cobb angle） and recovery of injured vertebral anterior height between 1 week and 1 year after operation （P〉0.05）. VAS significantly improved from preoperative （7.2±1.2） to （0.8±0.7） at 1 year after operation （t=18.47 ,P〈0.001 ）. Conclusion： Postural reduction with instrumental reduction is effective for thoracolumbar flexion-distraction fractures, and it is beneficial to the recovery of vertebral height and saggital alignment.