2种内固定方法治疗胸腰段椎体爆裂骨折的回顾性研究

Retrospective study of thoracolumbar burst fractures with short- or long-segment posterior pedicle fixation

目的 探讨短节段固定和长节段椎弓根内固定在治疗胸腰段椎体爆裂骨折的疗效。方法 回顾性分析自2006-03-2012-06行手术治疗的68例胸腰段椎体爆裂骨折的临床资料,对2组的手术时间、术中出血量、影像学指标以及脊髓功能恢复情况等进行比较。结果 65例获得随访,其中短节段固定组31例,长节段固定组34例,随访时间为12-37个月（平均18.4个月）。65例中出现断钉3例,均为短节段固定组,螺钉松动4例,其中1例为长节段固定组,3例为短节段固定组。短节段组的手术时间和术中平均出血量均要明显少于长节段组,2组间手术前后影像学指标（Cobb角、椎体前缘高度、椎管占位比）比较,差异无统计学意义（P〉0.05）。2组术后Cobb角以及椎管占位比均明显小于术前,椎体前缘高度相比术前则明显增加。2组神经功能恢复情况差异无统计学意义（P〉0.05）。结论 短节段固定与长节段椎弓根内固定治疗胸腰段椎体爆裂性骨折均能取得良好效果,短节段固定组创伤较小,但断钉或螺钉松动等并发症的发生率更高。

jObjective To compare short-segment （SS） versus long-segment （IS） pedicle instrumentation for treatingthoracolumbar burst fracture. Methods Sixty eight patients with thoracolumbar burst fracture underwent surgery, who wereadmitted to hospital between Mar. 2006 and Jun. 2012. The patients were divided into two groups （SS and LS） according to thenumber of instrumental levels. The operative time, intraoperative blood loss, radiological parameters and spinal functionrecovery were compared between two groups. Results Sixty five patients were followed-up with a mean time of 18.4 months（12-37 months）. Group SS included 31 patients, and group LS included 34 patients. During the follow-up, screw breakage wasobserved in 3 patients treated with SS posterior fixation. Screw loosening was found in 4 patients, 1 of them was treated with SSposterior fixation and the other 3 were LS posterior fixation. Compared with LS group, the mean operative time and intraoperativeblood loss were lower in SS group. However, there was no difference between the two groups in radiological parameters （Cobb angle, height of anterior vertebral body and canal compromise） and spinal function recovery（P 〉0.05）. The post-operative Cobbangle and canal compromise were significant lower than that before operation, the height of anterior vertebral body was increasedafter operation（P 〉0.05）. Conclusion Both SS and LS posterior pedicle fixation are effective treatment for thoracolumbar burstfractures. However, SS pedicle fLxation is a procedure associated with less invasive and higher complication rates.