胸腰椎B型骨折经伤椎单节段与跨伤椎短节段固定的对比研究

Posterior monosegment pedicle screw versus short segment pedicle screw instrumentation for type B thoracolumbar vertebral fracture

背景:后路经伤椎单节段固定与跨伤椎短节段固定是治疗胸腰椎B型骨折常用的方法,但两种术式的近远期疗效及各自优缺点尚未明确。目的:探讨后路经伤椎置钉单椎间椎弓根螺钉复位固定与传统跨伤椎短节段固定治疗创伤性B型胸腰椎骨折,治疗后脊柱稳定性及对固定相邻节段椎间盘退变的影响。方法:回顾性分析完成随访的AO分型B型胸腰椎骨折患者80例,按照不同的内固定方式分为经伤椎单节段固定组(n=40)和跨伤椎短节段固定组(n=45)。分别对两组患者的疼痛目测类比评分疼痛分级、ASIA脊髓功能分级、椎体前缘压缩率、椎管受堵指数、后凸Cobb角、UCLA相邻节段退变分级进行测量。结果与结论:两组在ASIA脊髓功能分级、椎管受堵指数、后凸Cobb角的疗效相当。而在手术时间、手术出血量、疼痛目测类比评分疼痛分级、椎体前缘压缩率、UCLA相邻节段退变分级,单节段组要优于短节段组。后路经伤椎单节段固定及传统的短节段固定在治疗胸腰椎B型骨折上都有显著的疗效,而单节段固定组在椎体前缘压缩率的改善及疼痛目测类比评分评分的改善情况要明显优于短节段组。此种手术方式还具有手术时间短、创伤小、减少固定节段以节省脊柱的活动节段,减少固定节段的相邻节段椎间盘退变的优点。

BACKGROUND：Both the posterior monosegment pedicle screw instrumentation and the traditional posterior short segment pedicle screw instrumentation are common surgical methods for treating type B thoracolumbar fractures. However, their advantages, short-term and long-term surgical outcomes are stil unclear. OBJECTIVE：To evaluate the stability of vertebra after posterior monosegment pedicle screw instrumentation and traditional posterior short segment pedicle screw instrumentation in the management of type B thoracolumbar fractures and the effects on intervertebral disc degeneration of adjacent segments. METHODS：We retrospectively analyzed 80 patients suffered from type B thoracolumbar fractures according to AO classification. The patients were divided into two groups according to the surgery they received. One was the traditional posterior short segment pedicle screw instrumentation group （n=45）, and the other was posterior monosegment pedicle screw instrumentation group （n=40）. The clinical therapeutic results were evaluated by measuring visual analogue scale score, ASIA classification, vertebral body compression rate, the index of vertebral canal occlusion, Cobb angle and UCLA arthritic grade respectively. RESULTS AND CONCLUSION：There were no statistical differences between the two groups in the ASIA neurological function classification, the occlusion index and the Cobb angle. However, operation time, bleeding amount, visual analogue scale scores, vertebral body compression rate and UCLA arthritic grade were better in＆amp;nbsp;the posterior monosegment pedicle screw instrumentation group than those in the traditional posterior short segment pedicle screw instrumentation group. Both the posterior monosegment pedicle screw instrumentation and traditional posterior short segment pedicle screw instrumentation showed great therapeutic results in the treatment of type B thoracolumbar fracture. The improvements in vertebral body compression rate and visual analogue scale scores were better in the posterior monosegment pedicle screw instrumentation group than those in the traditional posterior short segment pedicle screw instrumentation group. The posterior monosegment pedicle screw instrumentation also has many advantages such as less operation time, little trauma, preserving normal vertebrae segment and reducing intervertebral disc degeneration of adjacent segments.