2种术式治疗胸腰椎严重前柱损伤后骨缺损的对比研究

Comparative study of two surgical treatment of bone defect following severe thoracolumbar spine fractures

目的 以一期后路短节段植骨融合内固定联合伤椎骨水泥强化术与分期前后路切开复位融合内固定术治疗胸腰椎严重前柱损伤后骨缺损的疗效对比,探讨其适应证及优缺点。方法 自2009-01-2011-01对48例AO分型A3型胸腰段单椎体骨折随机施行骨水泥强化或前后路联合手术各24例。计算2种术式的手术时间、出血量,采用疼痛视觉模拟法（VAS）评分及Oswestry功能障碍指数（ODI）评分综合评估2种术式的手术疗效。结果 联合组获得随访平均23.2个月（18-36个月）,强化组获得随访平均21.8个月（18-24个月）。2组手术时间、出血量及住院时间比较,差异有统计学意义（P〈0.05）。2组VAS和ODI评分、Cobb角术后1周、末次随访时与术前比较,差异有统计学意义（P〈0.05）;术后1周与末次随访时比较,差异均无统计学意义（P〉0.05）;联合组与强化组各数据间比较,差异均无统计学意义（P〉0.05）。结论采用一期后路短节段植骨融合内固定联合伤椎骨水泥强化术治疗胸腰椎严重前柱损伤安全、近期疗效满意,可预防骨缺损形成后前柱不稳等并发症。

Objective To investigate indications, advantages and disadvantages by comparing teh effects of posterior short-segment fusion and internal fixation with injured vertebrae cement augmentation surgery and anterior and posterior approachspine fusion and internal f＇Lxation for the treatment of bone defects after severe thoracolumbar fracture. Methods From January2009 to January 2011, 48 patients with thoracolumbar vertebral fractures （AO A3-type）, underwent bone cement augmentationor anterior and posterior joint surgery, 24 cases each. All patients were single vertebral fractures. The surgery time, blood lossof two procedures were calculated. VAS score and ODI score were used to evaluate the e-cacy of two surgical procedures.Results The patients underwent anterior and posterior joint surgery were followed up for mean 23.2 months （18-36 months）,and patients underwent bone cement augmentation were followed up for mean 21.8 months （18-24 months）. Therere significantdifference in operative time, blood loss and length of stay between the two groups （P 〈0.05）. The VAS score, ODI score andCobb angle at one week after surgery and the last follow-up were significantly difference to those of pre-operation （P 〈0.05）,while no significant difference was found in VAS score, ODI score and Cobb angle at one week after surgery and the lastfollow-up （P 〉0.05）. No significant difference was found in the data between the two groups （P 〈0.05）. Conclusion Posteriorshort-segment fusion and internal fixation with injured vertebrae cement augmentation treatment of severe thoracolumbarfractures is safe, with satisfactory short-termresults. It can prevent bone defect formation and other complications.