后路长节段椎弓根螺钉固定治疗胸腰椎骨折的疗效评价

Efficacy of long-segment posterior pedicle screw fixation in treating thoracolumbar fractures

[目的]通过胸腰椎骨折后路长节段椎弓根螺钉固定术式与短节段固定术式的对比研究，探讨长节段固定治疗胸腰椎骨折的临床疗效。[方法]总结2008年1月一2011年12月采用后路长节段固定与后路短节段固定治疗的61例胸腰椎单椎体骨折患者的临床资料，分别记为长节段组（24例）和短节段组（37例）。比较两组患者手术时间、术中出血量、伤椎前缘高度比、矢状面Cobb角、神经功能恢复情况、疼痛视觉模拟评分（visual analoguescale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI）及内固定失败率等指标。神经功能采用ASIA分级评定。[结果]长节段组手术时间及术中出血量显著高于短节段组（P〈0．05）。随访14～32个月，平均20．2个月。两组患者末次随访时神经功能分级、VAS评分及ODI指数较术前显著改善（P〈0．05），但两组间比较差异无统计学意义（P〉0．05）。两组术后即刻及末次随访时伤椎前缘高度比、矢状面Cobb角较术前显著改善（P〈0．05）。两组间术后即刻伤椎前缘高度比及矢状面Cobb角比较差异无统计学意义（P〉0．05），而末次随访时长节段组伤椎前缘高度比及矢状面Cobb角优于短节段组，差异有统计学意义（P〈0．05）。随访期间，短节段组内固定失败5例，长节段组未发现内固定失败病例。[结论]后路长、短节段椎弓根螺钉内固定治疗胸腰椎骨折均可获得满意疗效，长节段固定术中出血量及手术时间较短节段明显增加，但在维持伤椎高度恢复、后凸畸形矫正方面，远期效果优于短节段固定。

[ Objective] A comparative study of long-and short-segment posterior pedicle screw fixation in the treatment of thoracolumbar fractures was made. [ Method] Sixty-one patients with single thoracolumbar fracture were treated by performing long-segment （ n = 24 ） or short-segment （ n = 37 ） posterior pedicle screw fixation from January 2008 to December 2011. The op- eration time, blood loss, anterior vertebral height ratio, Cobb angle, neurological function, pain measured by visual analogue scale （VAS） ,the Oswestry disability index （ODI） ,and the internal fixation failure rate were compared between the two groups. The American Spinal Injury Association （ASIA） grading system was used to evaluate neurological function. [ Result] The operation time and blood loss in the long-segment group were significantly higher than those in the short-segment group （ P 〈 0.05 ）. All patients were followed up for an average of 18.3 （range 14 -32 ） months. The neurological function, VAS and ODI at the last follow-up were significantly improved as compared to the pre-operative scores （P 〈 0.05 ） in both groups ; however, there was no significant difference between the two groups （ P 〉 0.05 ）. The anterior vertebral height ratio and Cobb angle were significantly improved in both groups immediately after operation and at the last follow-up than before the operation （ P 〈 0.05 ）. The anterior vertebral height ratio and Cobb angle were not significantly different between both groups （ P 〉 0.05 ） immediately after opera- tion, however, both were higher in the long-segment group at the last follow-up （P 〈 0.05 ）. During the follow-up period,5 pa- tients in the short-segment group showed internal fixation failure. No complications occurred in the other patients. [ Conclusionl Both long-and short-segment posterior pedicle screw fixation show satisfactory curative effect in the treatment of thoracolumbar fracture, while considering the long-term effect, long-segment posterior pediele screw fixation is better than short-segment method for maintaining recovery of vertebral body height and correction of deformity, despite a longer operation time and higher blood loss.