后路短节段固定融合与非融合治疗胸腰椎爆裂骨折的比较研究

COMPARISON OF SHORT SEGMENTAL FIXATION WITH AND WITHOUT FUSION IN TREATMENT OF THORACOLUMBAR BURST FRACTURE BY POSTERIOR APPROACH

目的比较后路短节段椎弓根螺钉固定融合与非融合治疗胸腰椎爆裂骨折的疗效。方法回顾分析2012年2月-2014年2月采用后路短节段椎弓根螺钉固定治疗,并符合纳入标准的57例单节段胸腰椎爆裂骨折患者临床资料,其中27例术中行融合（融合组）,30例未行融合（非融合组）。两组患者性别、年龄、致伤原因、受伤至入院时间、骨折节段及分型、神经功能美国脊髓损伤协会（ASIA）分级等一般资料比较,差异均无统计学意义（P〉0.05）,具有可比性。比较两组手术时间、术中失血量、住院时间。摄胸腰椎X线片,测量后凸Cobb角、伤椎高度和运动范围。采用Greenough腰痛评分法和疼痛视觉模拟评分（VAS）评价患者腰部功能恢复情况,参照ASIA分级标准评估神经功能恢复情况。结果与融合组相比,非融合组手术时间缩短、术中失血量减少,差异有统计学意义（P〈0.05）;两组住院时间比较,差异无统计学意义（P〉0.05）。两组患者均获随访;融合组随访时间为2.0~3.5年,平均3.17年;非融合组为2~4年,平均3.23年。X线片复查示,融合组2例植骨未达融合;其余25例均融合,融合时间12~17周,平均15.6周。术后融合组2例、非融合组1例出现切口相关并发症,其余切口均Ⅰ期愈合。两组术前、术后即刻及末次随访时Cobb角、伤椎高度比较,差异无统计学意义（P〉0.05）。术后1年（取出内固定物前）,两组伤椎运动范围比较,差异无统计学意义（P〉0.05）;非融合组术后1年均出内固定物,融合组术后1年时11例取出内固定物;末次随访时非融合组伤椎运动范围较融合组显著增加,比较差异有统计学意义（P〈0.05）。末次随访时,融合组与非融合组Greenough腰痛评分法评分、VAS评分以及ASIA分级比较,差异均无统计学意义（P〉0.05）。结论后路短节段椎弓根螺钉固定治疗胸腰椎爆裂骨折时无需进行融合,以保留伤椎运动功能,缩短手术时间,减少术中失血,避免取髂骨区相关并发症的发生。

Objective To compare the effectiveness of short segmental pedicle screw fixation with and without fusion in the treatment of thoracolumbar burst fracture. Methods A retrospective analysis was made on the clinical data of 57 patients with single segment thoracolumbar burst fractures, who accorded with the inclusion criteria between February 2012 and February 2014. The patients underwent posterior short segmental pedicle screw fixation with fusion in 27 cases（fusion group） and without fusion in 30 cases（non-fusion group）. There was no significant difference in gender, age, cause of injury, time between injury and admission, fracture segment and classification, and neurologic function America Spinal Injury Association（ASIA） classification between 2 groups, which had the comparability（P0.05）. The operative time, blood loss, and hospitalization days were compared between 2 groups. The height of the injured vertebra, the kyphotic angle, and the range of motion（ROM） were measured on the X-ray film. The functional outcomes were evaluated by using the Greenough low-back outcome score and the visual analogue scale（VAS） for back pain. The neurologic functional recovery was assessed by ASIA grade. Results The operative time was significantly shortened and the blood loss was significantly reduced in the non-fusion group when compared with the fusion group（P0.05）, but no significant difference was found in hospitalization days between 2 groups（P0.05）. The patients were followed up for 2.0-3.5 years（mean, 3.17 years） in the fusion group and for 2-4 years（mean, 3.23 years） in the non-fusion group. X-ray films showed that 2 cases failed bone graft fusion, the fusion time was 12-17 weeks（mean, 15.6 weeks） in the other 25 cases. Complication occurred in 2 cases of the fusion group（1 case of incision deep infection and 1 case of hematoma at iliac bone donor site） and in 1 case of the non-fusion group（fat liquefaction）; primary healing of incision was obtained in the others. The Cobb angle, the height of injured vertebrae showed no significant difference between 2 groups at preoperation, immediate after operation, and last follow-up（P0.05）. The ROM of injured vertebrae showed no significant difference between 2 groups at 1 year after operation（before implants were removed）（P0.05）. The implants were removed at 1 year after operation in all cases of the non-fusion group, and in 11 cases of the fusion group. At last followup, the ROM of injured vertebrae in the non-fusion group was significantly higher than that in the fusion group（P0.05）, but no significant difference was found in Greenough low-back outcome score, VAS score, and ASIA grade between 2 groups（P0.05）. Conclusion Fusion is not necessary when thoracolumbar burst fracture is treated by posterior short segmental pedicle screw fixation, which can preserve regional segmental motion, shorten the operative time, decrease blood loss, and eliminate bone graft donor site complications.