选择性伤椎置钉治疗胸腰椎爆裂骨折27例疗效分析

Selective pedicle screws in injured vertebra in the treatment of thoracolumbar burst fracture:efficacy analysis of 27 cases

目的 探讨选择性伤椎置钉治疗胸腰椎爆裂骨折的临床疗效.方法 回顾性分析我院2010年12月～2013年4月27例选择性伤椎置钉治疗单节段胸腰椎爆裂骨折患者的临床资料,男性17例,女性10例;年龄23 ～67岁,平均35.6岁.高处坠落伤14例,重物砸伤5例,道路交通伤7例,跌伤1例;骨折节段：T114例,T126例,L114例,L23例.比较术前及术后的伤椎高度比及脊柱后凸角度改善情况,用ODI评分量表（Oswestry Disability Index）评估患者临床症状及生活质量.结果 所有病例均手术顺利,平均随访20个月.伤椎高度比：术前与术后2周的差异有显著统计学意义（=0.387,P=0.000）,术后2周及末次随访的差异无统计学意义（=0.525,P=0.754）;矢状面Cobb角：术前与术后2周的差异有显著统计学意义（t=-0.302,P=0.027）,术后2周及末次随访的差异无显著性意义（t=0.149,P=0.618）;ODI评分：术后2周及末次随访的ODI评分差异无显著性意义（t=0.691,P=0.629）.结论 椎弓根螺钉固定联合选择性伤椎置钉治疗胸腰椎爆裂骨折的疗效满意,是安全、有效的手术方式.

Objective To evaluate the curative effect of selective pedicle screws in injured vertebra in the treatment of thoracolumbar burst fracture.Methods The clinical data of thoracolumbar burst fracture in 27 patients who were treated with selective pedicle screws in the injured vertebra from Dec.2010 to Apr.2013 was analyzed retrospectively.The preoperative and postoperative Cobb angles and fractured vertebra height rates were compared to assess the recovery before and after surgery.Oswestry Disability Index was used to evaluate the pain level and quality of life.Results All patients underwent surgery successfully.The average follow-up period was 20 months.There was significant difference in fractured vertebra height rates and Cobb angles before and after operations （t =0.387,P =0.000 ; t =-0.302,P =0.027） while no significant difference between postoperative and last follow-up.And there was no significant difference in Oswestry Disability Index between postoperative and last follow-up（t =0.691,P =0.629）.Conclusion Selective pedicle screws in injured vertebra in the treatment of thoracolumbar burst fracture is a safe and effective operative mode with satisfactory effect.