三种伤椎置钉固定胸腰椎爆裂骨折的疗效对比

Comparison of three pedicle screw placements in the fractured vertebra for posterior internal fixation of thoracolumbar burst fractures

[目的]探讨后路不同内固定方式治疗胸腰椎爆裂性骨折的临床疗效。[方法]2009年2月~2015年7月对116例胸腰椎爆裂性骨折患者行后路复位固定手术治疗,按手术方式将患者分为三组,38例采用伤椎椎弓根内置短螺钉(伤椎短钉组),38例采用伤椎椎弓根内置长螺钉(伤椎长钉组),40例后路短节段椎弓根钉内固定伤椎不置螺钉(伤椎无钉组)。[结果]随访9~36个月,平均15.8个月。三组手术前后伤椎前缘高度比、脊柱后凸Cobb角、伤椎椎管矢状径和横截面积比较均有明显改善,差异有统计学意义(P<0.01)。术后神经功能状态较术前有显著改善,差异有统计学意义(P<0.05)。伤椎短钉组、伤椎无钉组在术后矫正率、术后椎管面积改善率,优于伤椎长钉组,组间比较差异有统计学意义(P<0.05)。伤椎短钉组和伤椎长钉组的远期矫正丢失率和内固定失效率均低于伤椎无钉组(P<0.05)。三组间神经功能恢复比较差异无统计学意义(P>0.05)。术后疼痛评分伤椎短钉组优于伤椎长钉组和伤椎无钉组(P<0.05)。术后并发症三组无显著差别。[结论]在后路内固定中增加经伤椎椎弓根内置短螺钉内固定是治疗胸腰椎爆裂性骨折的更有效手段。

[Objective] To compare the clinical outcomes of three pedicle screw placements in the injured vertebra for posterior internal fixation of thoracolumbar burst fractures. [Method] From February 2009 to July 2015, 116 patients who suffered from thoracolumbar burst fractures were surgically treated by posterior reduction and internal fixation with pedicle screw and rod system. The patients was divided into three groups according to pedicle screw placement in the injured verte- bra, including 38 patients treated with short pedicle screw insertion in the injured vertebra （the short screw group）, 38 with long pedicle screw insertion in the affected part （the long screw group）, as well as 40 without pedicle screw placement in the fractured segment （the non-screw group） . [Results] All of the patients were followed up for 9 to 36 months with an average of 15.8 months. Compared with the corresponding data prior to operation, height ratio of anterior edge of injured verte- bral body, kyphosis Cobbs angle, sagittal diameter and cross-sectional area of injured vertebral canal, as well as ASIA2000 scale improved significantly in all of the three groups at the latest follow up （P 〈 0.01） . The correction rate of ky- phosis and improvement rate of spinal canal area in the short screw group and the non-screw group were superior to those in the long screw group （P 〈 0.05） . However, the rates of long-term correction loss and failure of internal fixations in the short screw group and the long screw group were significantly lower than that of the non-screw group （P 〈 0.05） . Recovery of neu- rological function was not significantly different among three groups （P 〉 0.05） . The postoperative pain based on Denis score in the short screw group relieved much better than that of the long screw group and the non-screw group （P 〈 0.05） . In term of postoperative complications, there were no significant differences among the three groups. [Conclusion] Posterior internal fixation combined with short pedicle screw placement in the fractured vertebra has a better clinical outcome in the treatment of thoracolumbar burst fracture.