经后路单侧伤椎固定治疗胸腰椎骨折的临床应用

Clinical applications of unilateral vertebral pedicle screw in the treatment of thoracolumbar fractures

目的比较单侧伤椎置钉与跨伤椎椎弓根内固定治疗胸腰椎骨折的临床疗效。方法回顾性分析2008年7月至2012年7月40例胸腰椎骨折患者,将其分为经单侧伤椎置钉结合经椎弓根植骨组(A组)和跨伤椎椎弓根内固定结合经椎弓根植骨组(B组),每组20例。比较两组在术后1个月及术后2年的伤椎前缘高度、椎管正中矢状径、脊柱后凸角(Cobb角)、视觉模拟评分法(VAS)评分、Frankel分级等情况。结果术后1个月两组伤椎前缘高度、椎管正中矢状径、Cobb角、VAS评分比较,差异无统计学意义(P>0.05)。术后2年伤椎前缘高度、Cobb角两项指标,A组优于B组,差异有统计学意义(P<0.05)。两组术后脊髓神经功能恢复情况均良好,比较差异无统计意义(P>0.05)。结论经后路单侧伤椎椎弓根钉内固定结合经椎弓根植骨术能重建椎体高度,使脊柱的载荷分布更加合理,降低内固定失败率,减少矫正丢失,是治疗胸腰椎骨折的有效方法之一。

Objective To compare the curative effect for thoracolumbar fractures by the method between unilateral injured vertebral pedicle screw fixation and beyond injured vertebral internal fixation. Methods Clinical data of 40 cases of thoracolumbar burst fractures were retrospectively analyzed from July 2008 to July 2012. All the cases were followed up for 1 to 24 months,which were divided into two groups：group A： unilateral vertebral pedicle screw fixation combining transpedicular bone graft （n =20）; group B..adjacent upper and lower vertebral of fractured vertebra pedicle fixation combining transpedicular bone graft（n=20）. The clinical curative effect were compared by measuring the height of anterior border,the percentage of mid-sagital diameter, the Cobb angle,visual analogue scale （VAS）classification and Frankel＇s neurological function classification 1 month after operation and 2 years afer operation. Results There were no statistical differences between the two groups in the height of anterior border,the percentage of mid-sagital diameter,the Cobb angle, VAS classification I month after operation（P〉0.05）. After 2 years of follow up, the group A was better than the B group in the two indexes of the anterior height and the Cobb angle of the injured vertebra, the difference was statistically significant（P〈0.05）. The postoperative recovery of spinal nerve function of two groups was good, the difference was not statistically significant（P〉0.05）. Conclusion Unilateral vertebral pedicle screw fixation with transpedicular bone graft can not only reconstruct the height of verbebral fractured satisfactorily, making load of spine more reasonable, but also decrease the possibility of breaking nail and correction loss. Mean while it is an effective method in treatment of thoracolumbar burst fractures.