2种椎弓根钉内固定术治疗爆裂与脱位型腰椎骨折手术效果的比较

Operation results of rupture type and dislocation type lumbar fractures

目的评价后路经伤椎椎弓根钉内固定术治疗爆裂型、脱位型腰椎骨折的手术效果。方法本院自2009-01—2012-04诊治42例爆裂型、脱位型腰椎骨折,随机分为观察组和对照组各21例,分别应用后路经伤椎椎弓根钉内固定术与单纯行跨骨折椎短节段内固定术进行治疗,比较分析2组伤椎前缘高度及Cobb角、神经功能恢复情况及术后内固定松动断裂发生情况。结果 2组术后3个月与12个月时伤椎前缘高度及Cobb角与术前比较差异均有统计学意义(P<0.05),但组间比较差异无统计学意义(P>0.05);2组术后神经功能恢复情况比较差异无统计学意义(P>0.05);对照组术后发生内固定松动4例,断裂1例,发生率为23.8%,观察组发生内固定松动1例,发生率为4.8%,明显低于对照组,差异有统计学意义(P<0.05)。结论采用后路经伤椎椎弓根钉短节段固定术治疗爆裂型和脱位型腰椎骨折,能够较好地重建椎体高度,恢复生理曲度,促进神经功能恢复,同时并发症发生率低,安全性高。

Objective To evaluate the operation results of posterior pedicle screw fixation for treatment of rupture type and dislocation type lumbar fractures. Methods From Jan. 2009 to Apr. 2012, 42 cases were chosen and randomly divided into observation group and control group each with 21 cases. They were separately given posterior pedicle screw fixation and simple cross fractured-vertebra fixation. Conditions of fractured vertebra frontal edge height, Cobb angle, neural function recovery and occurrence of loosening and fracture of internal fixation after operation of the 2 groups were compared. Results There were significant differences in fractured vertebra frontal edge height and Cobb angle before and 3 and 12 months after operation（ P〈0.05）, but no significant differences between two groups（P〉0.05）. There were significant differences between the 2 groups in neural function recovery condition（P〉0.05）. After operation, there were 4 cases with loosening of internal fixation and 1 case with break of internal fixation fracture in control group with an occurrence rate of 23.8% while there was 1 case with loosening of internal fixation in observation group with an occurrence rate of 4.8%（P〈0.05）. Conclusion Posterior pedicle screw fixation for treatment of rupture type and dislocation type lumbar fractures can nicely rebuild vertebral height, recover physiological curvature, and enhance neural function recovery. Meanwhile, it has a low complication occurrence rate and a high safety.