经伤椎短节段治疗胸腰段A型骨折的临床疗效

Clinical effect of short segment fixation via the injured vertebra in treatment of the type A thoracolumbar fractures

目的：探讨经后路短节段伤椎固定在胸腰段A型骨折的临床疗效。方法：回顾性分析2010年8月至2013年9月共收治胸腰段A型骨折患者78例，A组41例患者行后路伤椎短节段固定，B组37例患者行后路跨伤椎短节段固定。观察患者术前、术后1周、末次随访Cobb角及伤椎前缘椎体高度；同时比较两组椎体前缘压缩率（anterior height ratio，AHR）及胸腰椎疼痛视觉模拟评分（VAS）、术中出血量及手术时间。结果：78例患者术后获16-22个月随访，平均随访18．4个月，术前、术后两组患者Cobb角、AHR组内存在统计学差异，组间比较差异无统计学意义；末次随访A组Cobb角丢失（2．62±1．98）°，小于B组（5．54±3．17）°（P=0．054）；末次随访A组伤椎压缩率丢失（3．76±2．23）％，小于B组（6．28±3．42）％（P=0．056）；两组患者术前、术后、末次随访VAS评分比较差异无统计学意义（P〉0．05）。结论：跨伤椎短节段固定与经伤椎短节段固定治疗胸腰椎A型骨折短期临床疗效相似，后路短节段伤椎固定椎体高低丢失优于跨伤椎短节段固定，其有更助于稳定伤椎，恢复其解剖结构，增强脊柱力学稳定性。

Objective To discuss the clinical effects of posterior short segment fixation via injured vertebra for thoracolumbar fractures. Methods From August 2010 to September 2013, 78 patients had the type A thoracolumbar fractures. Forty-one patients with posterior short segment fixation via injured vertebra were distributed in Group A and 37 patients with posterior short segment fixation across injured vertebra in Group B. We observed the anterior height of the injured vertebra and Cobb angle before surgery and in a week after surgery and the end of follow-up. The anterior vertebral compression rate of anterior height ratio （AHR）, thoracic and lumbar pain visual analogue score （visual analogue scale, VAS）, the operation time and blood loss of the two groups were also compared between the Group A and the Group B. Results Seventy-eight patients were followed up from 16 to 22 months （mean, 18.4 months）. For preoperative and postoperative Cobb angle and AHR, there were significant differences within the groups and no significant differences between the groups. At the end of the follow-up, Cobb angle loss （2.62 ± 1.98）° in the group A, which is significantly lower than （5.54 ±_ 3.17）° （P = 0.054） in the group B. At the end of the follow-up, vertebral compression loss rate is 3.76 ± 2.23% in the group A, which is significantly less than（6.28 ± 3.42）%（P = 0.056）in the group B. VAS score was not statistically significant （P 〉 0.05） at preoperative, postoperative and the last follow-up. Conclusion The clinical effects are similar between posterior short segment fixation via injured vertebra and short segment fixation across injured vertebra in the treatment of the type A thoracolumbar fractures in short-temp. The loss of the vertebral height in short segment fixation via injured vertebra was less than that in short segment fixation across injured vertebra. It contributes to the stability of vertebral injury, restores the anatomic structure and enhances the mechanical stability of the spine.