伤椎置钉与否对经皮短节段固定治疗胸腰椎骨折疗效的影响

Therapeutic influence caused by injured vertebra fixed or not in treating thoracolumbar fractures with percutaneous short-segment fixation

目的探讨伤椎置钉与否对微创经皮椎弓根钉短节段固定治疗胸腰椎骨折疗效的影响。方法将40例单节段胸腰椎骨折患者按手术方式分为两组：微创经皮椎弓根钉短节段固定并伤椎置钉组（A组,20例）和单纯微创经皮椎弓根钉短节段固定组（B组,20例）。对两组患者的围手术期指标及术后的治疗效果进行比较。结果所有患者均获得随访,时间6~24个月。手术时间、术中出血量、术后第3天疼痛VAS评分两组比较差异均无统计学意义（P〉0.05）;术后及末次随访伤椎Cobb角、伤椎前缘高度比值、椎管占位（Wolter指数）A组均优于B组,差异均有统计学意义（P〈0.001）;末次随访ODI评分A组优于B组（P〈0.001）。结论微创经皮短节段固定并伤椎置钉治疗胸腰椎骨折较单纯微创经皮短节段固定增加了少量创伤,但有更好的远期疗效。

Objective To explore the influence of curative effect of the injured vertebra fixed or not of minimally invasive percutaneous pedicle screws short-segmental fixation in treatment of thoracolumbar fracture. Methods 40 patients with single-segment thoracolumbar fracture were divided into two groups according to the operative methods：minimally invasive percutaneous short-segment fixation with injured vertebra fixed group（ Group A,n = 20） and pure minimally invasive percutaneous short-segment fixation group（ Group B,n = 20）. The perioperative parameters and the postoperative therapeutic effect between two groups were compared. Results All patients were followed up for6 ~ 24 months. The differences had no statistical significance in the operative time,volume of bleeding and VAS on the third day postoperation between two groups（ P〈0. 05）. Group A had better outcome on Cobb angle,the ratio of height of injured vertebra anterior edge and the spinal canal stenosis（ Wolter index） than Group B,whenever in the postoperative or last follow-up,the differences had statistical significance（ P〈0. 001）; group A had better outcome on ODI index than Group B in the last follow-up（ P〈0. 001）. Conclusions Although minimally invasive percutaneous short-segment fixation with injured vertebra fixed in treating thoracolumbar fractures add a little more invasion than minimally invasive percutaneous short-segment fixation,it lead to better long-term effects.