短节段经伤椎椎弓根螺钉固定治疗胸腰段骨折的中期疗效观察

Fixation of thoracolumbar fractures with posterior short-segment pedicle screws at the fracture level： the mid-term results

目的探讨短节段经伤椎椎弓根螺钉固定治疗胸腰段骨折的中期疗效。方法回顾性研究2008年1月至2009年12月收治的78例单节段胸腰段骨折患者资料，男50例，女28例；年龄23—60岁，平均（43．6±2．9）岁；均为AO分型A型损伤。根据治疗方法不同分为采用短节段经伤椎椎弓根螺钉固定组（A组，40例）和短节段椎弓根螺钉内固定组（B组，38例）。两组患者术前一般资料比较差异均无统计学意义（P〉0．05），具有可比性。比较两组患者末次随访时的Frankel分级、并发证发生率，以及术后3d、内固定取出前的视觉模拟评分（VAS）、椎体前、中、后缘高度、cobb角。结果所有患者术后获40—55个月（平均49个月）随访。两组患者术后末次随访时Frankel评级改善率（85．0％ vs.90．5％）和并发症发生率（5．0％ vs．7．9％）比较差异均无统计学意义（P〉0．05）。所有患者末次随访时的VAS评分、伤椎前、中缘高度、cobb角均较术前明显改善，差异有统计学意义（P〈0．05）。A组患者末次随访时的VAS评分、伤椎前缘高度、cobb角改善均优于B组，差异有统计学意义（P〈0．05）；两组患者末次随访时的伤椎中、后缘高度比较差异均无统计学意义（P〉0．05）。结论两种手术方法均是治疗胸腰段骨折的可靠方法，短节段经伤椎椎弓根螺钉固定不仅增加内固定的强度，为椎体骨折愈合提供更为稳定的系统，而且体现出椎体高度及后凸矫正丢失少的优点。

Objective To analyze the mid-term results of fixation of thoracolumbar fractures with posterior short-segment pedicle screws at the fracture level. Methods From January 2008 to December 2009, 78 patients with monosegmental thoraeolumbar fracture were treated at our department. They were 50 men and 28 women, from 23 to 60 years of age （average, 43.6 ± 2. 9 years）. By AO classification, they were all of type A. Fixation at the fracture level with posterior short-segment pedicle screws was used in 40 patients （Group A） and classic fixation with short-segment pediele screws in 38 patients （Group B）. The 2 groups were compatible in preoperative clinical data （ P 〉 0. 05）. The 2 groups were compared in terms of anteroposterior and lateral X-ray films of the thoraeolumbar vertebrae, visual analogue scale （VAS） scores and Frankel grading at preoperation, postoperation, before removal of implants and the last follow-up. Results The 78 patients were followed up for 40 to 55 months （mean, 49 months）. There were no statistically significant differences between the 2 groups in Frankel grading （85.0% versus 90. 5% ） or rate of complications （5.0% versus 7.9% ） at the last follow-up （ P 〉 0. 05） . All the patients obtained significant improvements at the last follow-up in VAS score, anterior and middle heights of the injured vertebra, and cobb angle compared with preoperation （ P 〈 0. 05）. At the last follow-up, the VAS score, the anterior height of the injured vertebra and cobb angle in group A were siguificautly better than in group B（ P 〈 0.05）; the differences in the anterior and middle heights of the injured vertebra were not significant between the 2 groups （ P 〉 0. 05 ）. Conclusions Both methods of fixation are reliable treatments of thoracolumbar fractures. Short-segment pedicle screw fixation at the fracture level may increase the strength of fixation, providing a more stable system for fracture healing to reduce loss of vertebral heights and kypbosis correction.