Quadrant通道下伤椎置钉固定治疗胸腰椎骨折的效果及安全性

Effect and safety of pedicle screw fixation in treatment of thoracolumbar fracture of vertebral Quadrant channels

目的探讨Quadrant通道下伤椎置钉固定治疗胸腰椎骨折的效果及安全性。方法选择河源市人民医院2012年11月～2013年11月收治的胸腰椎骨折患者60例，随机分为观察组和对照组，每组各30例。观察组采用Quadrant通道下伤椎置钉固定，对照组采用传统跨节段椎弓根螺钉固定。观察并比较两组手术时间和术中出血量。以及治疗前后腰椎功能JOA评分、伤椎前后缘高度比、后凸畸形Cobb角、疼痛VAS评分、Frankel脊髓神经功能障碍分级情况。结果经随访，观察组患者骨折均愈合良好，未出现任何并发症，对照组有2例发生切口感染，3例出现内固定失败。手术时间和术中出血量方面，观察组均显著低于对照组，差异有统计学意义（均P〈0．05）。两组治疗前腰椎功能JOA评分、伤椎前后缘高度比、后凸畸形Cobb角、疼痛VAS评分差异均无统计学意义（均P〉0．05）；治疗后，两组在疼痛VAS评分方面差异有统计学意义（P〈0．05），腰椎功能JOA评分、伤椎前后缘高度比、后凸畸形Cobb角差异均无统计学意义（均P〉0．05）。观察组在Frankel脊髓神经功能障碍分级方面的改善情况显著优于对照组（均P〈0．05）。结论采用Quadrant通道下伤椎置钉固定来治疗胸腰椎骨折，手术时间短，术中出血量少，能有效缓解患者的腰背部疼痛症状，且并发症较少，值得临床大力推广。

Objective To explore the effect and safety of pedicle screw fixation in treatment of thoracolumbar fractures of vertebral Quadrant channels. Methods 60 patients with the thoracic and lumbar spine fractures in Heyuan People＇s Hospital from November 2012 to November 2013 were selected and divided into the observation group and the control group, with 30 cases in each group. The observation group was treated with the fixation of vertebral Quadrant channels, the control group was treated with the traditional cross segment pedicle screw fixation. The operation time and intraoperative bleeding, as well as before and after lumbar function before and after treatment with JOA score, vertebral height, kyphosis margin Cobb angle, VAS pain score, Frankel spinal nerve function grading of the two groups were ob- served and recorded. Results During follow-up, fractures of patients in the observation group healed well, no complications was found. 2 cases of infection, 3 internal fixation failure in control group were found. The operation bleeding amount and operation time of the observation group were lower than those of the control group, the differences were statistically significant （all P 〈 0.05）. Before treatment, the differences of the JOA score for lumbar function, vertebral posterior height ratio, kyphosis angle Cobb, VAS pain scores between the two groups were not significantly significant （all P 〉 0.05）; after the treatment, the difference of pain VAS score between the two groups were significantly significant （P 〈 0.05）; but the difference of the JOA score for lumbar function, vertebral posterior height ratio, kyphosis angle Cobb between the two groups were not significantly significant （all P 〉 0.05）. The improve situation of Frankel spinal nerve dysfunction grading of the observation group was significantly better than that of the control group, the difference was statistically significant （P 〈 0.05）. Conclusion The Quadrant channel vertebral pedicle screw fixation for the treatment of thoracolumbar fracture has short operation time, less bleeding, it can effectively relieve the lumbar back pain, and has less complications, it is worthy of clinical promotion.