比较经伤椎与跨伤椎内固定术在治疗胸腰椎骨折的临床疗效

Comparison of curative effect of different fixation methods in treatment of thoracolumbar spine fractures

目的对比分析跨伤椎固定术与经伤椎固定术在治疗胸腰椎骨折患者的临床疗效。方法回顾性分析我院收治的胸腰椎骨折患者86例,根据手术方式不同分为两组,跨伤椎固定术治疗45例(跨伤椎组),经伤椎固定术治疗41例(经伤椎组),比较两组患者的手术时间、术中出血量,术前、术后椎体前缘高度、椎体后凸Cobb角值、疼痛视觉模拟评分(visual analogue scale,VAS)、美国脊髓损伤协会(American Spinal Injury Association,ASIA)神经功能分级标准及并发症发生率。结果经伤椎组手术时间较跨伤椎组长,两组比较差异有统计学意义(t=5.151,P=0.000)。两组术后即刻、6个月及12个月的椎体前缘高度、椎体后凸Cobb角、VAS评分均较术前改善,差异均有统计学意义(均P<0.05)。经伤椎组术后椎体高度、椎体后凸Cobb角、VAS评分显著高于跨伤椎组,差异均有统计学意义(均P<0.05)。经伤椎组的ASIA神经功能分级改善率高于跨伤椎组。结论经伤椎固定术治疗胸腰椎骨折在椎体高度、椎体后凸Cobb角恢复,降轻疼痛,提高神经功能方面效果良好。

Objective To compare the clinical efficacy of cross-vertebral fixation and by-vertebral fixation in treatment of thoracolumbar spine fractures. Methods Eighty-six cases of thoracolumbar spine fractures were retrospectively analyzed in our hospital and divided into 2 groups including cross-vertebral group （45 cases） with cross-vertebral fixation and by-vertebral group （41 cases） with by-vertebral fixation. The operation time, the blood loss, the height of vertebral anterior edge, Cobb angle, VAS score before and after operation, neurological function and the complications between two groups were compared. Results Operation time in by-vertebral group was significantly longer than in cross-vertebral group （t=5.151, P=0.000）;The height of vertebral anterior edge, Cobb angle, and VAS score in both two groups immediate, 6 months and 12 months after operation were significantly increased as compared with those before operation （all P〈0.05）;The ASIA grade postoperative improvement rate in by-vertebral group was higher than in cross-vertebral group. Conclu-sion By-vertebral fixation in treatment of thoracolumbar spine fractures could obtain satisfactory effectiveness, including promoting the recovery of vertebral height and Cobb angle, reducing the pain degree and improving the nerve function.