短节段椎弓根螺钉内固定结合伤椎植骨植钉术在胸腰椎骨折的应用

Application of short-segment pedicle screw fixation combined with stud injured vertebra bone surgery in the thoracolumbar fractures

目的比较短节段椎弓根螺钉内固定结合伤椎植骨植钉术与跨节段椎弓根螺钉内固定术治疗胸腰椎爆裂或压缩骨折的临床疗效。方法将46例胸腰椎爆裂或压缩骨折患者随机分为2组,分别使用短节段椎弓根螺钉内固定结合伤椎植骨植钉术和跨节段椎弓根螺钉内固定结合伤椎植骨术治疗。比较两组手术时间、术中出血量、术后Cobb角、伤椎前缘高度压缩率、椎间隙高度丢失、神经功能恢复(Frankel分级)、JOA评分及VAS评分。结果两组患者手术时间和术中出血量比较,差异均无统计学意义(P>0.05)。术后12个月神经功能Frankel分级差异无统计学意义。术后各时间点观察组、对照组Cobb角、各椎间隙高度、VAS评分及JOA评分比较差异无统计学意义(P>0.05)。结论短节段椎弓根螺钉内固定结合伤椎植骨植钉术治疗胸腰椎爆裂或压缩骨折能有效恢复并维持伤椎高度,但不能有效地防止相邻节段的退变和后凸畸形矫正度的丢失。

Objective To compare the effects of short-segment pedicle instrumentation with bone grafting and pedicle screw implanting in injured vertebra and cross segment pedicle instru-mentation with bone grafting in injured vertebra for treating thoracolumbar fractures. Methods 46 patients with thoracolumbar fracture were randomly divided into two groups. 23 cases in group A received treatment with short-segment pedicle screw instrumentation with bone grafting and pedicle screw implanting in injured vertebra,and 23 cases in control group received treatment with cross segment pedicle instrumentation with bone grafting in injured vertebra. The operation time, blood loss,Cobb angle,compression rate of anterior vertebral height,loss of disc space height, Frankel grade,VAS and JOA scores were compared between the two groups. Results There were no sig-nificant differences in the operation time and blood loss between two groups （P〉0.05）. The Cobb angle,compression rate of anterior verterbral height,and VAS score at 1 week and 12 months,and JOA score at 12 months were significantly improved when compared with preoperation in two groups（P〈0.05）. No significant differences were found in Cobb angle,disc space height,VAS score, and JOA score between two groups at each time point （P〉0.05）. Conclusion Short-segment pedi-cle screw instrumentation with bone grafting and pedicle screw implanting in injured vertebra can recover and maintain the affected vertebra height in treating thoracolumbar fractures,but it can not effectively prevent degeneration of adjacent segments and the loss of kyphosis correction degree.