经伤椎固定与单纯短节段椎弓根钉内固定治疗AO-A型胸腰椎骨折的疗效比较

Comparison of effectiveness between injured vertebra fixation versus simple shortsegment pedicle screw fixation in AO type-A thoracolumbar fractures

目的比较经伤椎固定与单纯短节段内固定治疗AO分型中A型胸腰椎骨折的临床疗效。方法回顾性分析自2005-01—2012-12诊治的46例A型胸腰椎骨折,采用经伤椎椎弓根钉内固定治疗24例（经伤椎组）,采用单纯短节段椎弓根钉内固定治疗22例（跨伤椎组）。比较2组VAS评分、术后至取出内固定时间,以及Cobb角、伤椎后凸角、伤椎高度的矫正及丢失情况。结果 46例均获得平均21.2（10~42）个月随访。经伤椎组3例出现螺钉松动;跨伤椎组1例出现螺钉松动,2例出现螺钉断裂。2组术后VAS评分均较术前明显降低,差异有统计学意义（P〈0.001）。2组术后至取出内固定时间比较差异无统计学意义（t=0.270,P=0.791）。2组术后即刻、取内固定时Cobb角及Cobb角矫正度数、丢失角度,术后即刻、取内固定时伤椎后凸角及伤椎后凸角矫正度数、丢失角度,以及术后即刻、取内固定时伤椎前缘压缩率及伤椎矫正高度、丢失高度比较差异无统计学意义（P〉0.05）。结论经伤椎固定与单纯短节段内固定治疗A型胸腰椎骨折均可达到有效复位固定,二者的临床疗效无明显差异。

Objective To compare the clinical effectiveness between injured vertebra fixation and simple short-segment pedicle screw fixation for the treatment of AO type-A thoracolumbar fractures. Methods A total of 46 patients who underwent operative treatment for AO type-A thoracolumbar fractures from January 2005 to December 2012 were retrospectively reviewed. Twenty four patients underwent short-segment fixation with additional screws at the level of fracture （injured vertebra fixation group） and 22 patients without screws at the level of fracture （cross-segment fixation group）. Indicators were compared between two groups,including VAS scale, time interval between initial surgery and implant removal, and degree of correction and loss in the vertebral height, Cobb angle and kyphosis angle. Results The mean follow-up duration was 21.2 months （range, 10-42 months）. There were 3 cases of screw loosening in the injured vertebra fixation group, 1 case of screw loosening and 2 cases of screw breakage in the cross-segment fixation group. The mean VAS scales in both two groups were significantly decreased at final follow-up （P 〈0.001）. There was no significant difference between two groups in the time interval from initial surgery to implant removal （t =0.270, P =0.791）. No significant differences were observed between two groups in the Cobb angle immediately after initial surgery and before implant removal, degree of correction and loss of Cobb angle, kyphosis angle immediately after initial surgery and before implant removal, degree of correction and loss of kyphosis angle, injured vertebral compression ratio immediately after initial surgery and before implant removal, and degree of correction and loss of injured vertebral compression ratio （P 〉0.05）. Conclusion Both injured vertebra fixation and simple short-segment pedicle screw fixation show satisfa＆ory outcomes in the treatment of AO type-A thoracolumbar fractures, which can achieve sufficient restoration and stabilization.