经骨折椎体椎弓根螺钉短节段固定治疗胸腰段骨折疗效

Effectiveness of Short-Segment Fixation of Lumbar Burst Fractures Using Pedicle Fixation at the Level of the Fracture

目的:评估和分析经骨折椎体椎弓根螺钉短节段固定治疗胸腰段单椎体粉碎性骨折的临床疗效。方法:选取胸腰段单椎体粉碎性骨折30例患者,分为两组,甲组20例,采用经骨折椎体椎弓根螺钉短节段固定治疗,均行骨折椎体及骨折椎体上下相邻椎体的椎弓根螺钉+双侧连接杆固定;乙组10例,只行骨折椎体的上下相邻椎体的椎弓根螺钉+连接杆固定术。术后随访。测定两组患者手术前后的椎体后凸畸形角和骨折椎体前方高度,评估其临床疗效。结果:术前平均后凸畸形角纠正:甲组15°,乙组11°,P<0.05。术后骨折椎体前方的平均高度(和正常椎体前方高度比):甲组89%,乙组81%,P<0.05;术后3个月随访:平均后凸畸形角纠正丢失,甲组2°,乙组6°,P<0.05;骨折椎体前方的平均高度(和正常椎体前方高度比):甲组87%,乙组73%,P<0.05。结论:经骨折椎体椎弓根螺钉短节段固定治疗胸腰段单椎体粉碎性骨折能提供更好的生物力学稳定性,更有利于骨折的复位和后凸畸形的纠正。

Objective： To evaluate and analyze the effectiveness of short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture. Methods： A retrospective study was performed in 30 patients with the only-one thoracolumbar burst fractures treated with the pedicle screws and rods. Twenty cases were treated by pedicle screw fixation through the pedicle of fractured vertebra and the adjacent vertebra（A group）. Ten cases were treated by pedicle screw fixation through the adjacent vertebra（B group）.Radiological evaluation was made for measuring Cobb＇s angle and the anterior height of injured vertebra before and after operation and during the following up. The data was analyzed statistically by using the SPSS 20.0 statistical software. Results： The mean preoperative kyphotic deformity was improved by 15° and 11° after surgery in A and B groups, and the difference was statistical significant（P〈0.05）; and the mean anterior vertebral body height was 89 % and 81 % of normal after operation with statistical significance（P〈0.05）. In 3months of follow up after operation, there were 2° and 6° of kyphosis correction loss in A and B groups, P〈0.05. Conclusions： The segmental fixation of burst fractures with screws at the level of the fracture offer improved the biomechanical stability, and theoretically provide for additional fixation points, so it may contribute to the fracture reduction and kyphosis correction.