前路钢板与后路椎弓根螺钉固定治疗颈椎骨折脱位的效果比较

Comparison of the Anterior Cervical Steel Plate Fusion and Posterior Pedicle Screw Fixation for Treatment of Cervical Fracture Dislocation

目的比较前路钢板与后路椎弓根螺钉固定治疗颈椎骨折脱位的疗效。方法选取2012年6月至2013年12月榆林市第一医院收治的颈椎骨折脱位患者90例为研究对象,根据随机数字法分为前路钢板内固定组(40例,采用前路钢板治疗)和后路椎弓根内固定组(50例,采用后路椎弓根内固定手术治疗)。比较两组术中出血量、手术时间以及住院时间,患者术后的一般情况、Frankle分级情况以及JOA评分情况。结果两组患者均无严重并发症发生,术后随访期间均未出现内固定松动及断裂等现象;两组患者的手术时间比较,差异无统计学意义(P>0.05),前路钢板内固定组患者的出血量和住院时间均短于后路椎弓根内固定组[(103±33)m L比(223±38)m L、(9±3)d比(14±3)d](P<0.01);治疗后,两组患者Frankle分级均较治疗前改善,且后路椎弓根内固定组改善情况优于颈前路钢板内固定组(P<0.05)。随治疗后时间的延长,两组患者的JOA评分均较治疗前显著升高,其中后路椎弓根内固定组稍高于前路钢板内固定组,两组患者的JOA评分在组间、时点间以及组间·时点间比较,差异均有统计学意义(P<0.01)。结论后路椎弓根螺钉固定治疗颈椎骨折脱位患者术后神经功能的恢复较前路钢板更为理想,当然临床需结合具体的损伤情况和严重程度选择最佳治疗方案。

Objective To compare the efficacy of anterior cervical steel plate fusion and posterior pedicle screw fixation for treatment of cervical fracture dislocation. Methods A total of 90 patients who suffered with cervical fracture and dislocation from Yulin First Hospital during Jun. 2012 and Dec. 2013 were collected ,and they were divided into an anterior cervical steel plate fusion group（40 cases, treated with anterior cervical steel plate fusion） and a posterior pedicle fixation group （50 cases, treated with posterior pedicle screw fixation）. The operation time, blood loss and length of hospital stay, the general appearance, Frankle classification and JOA score of the two groups were compared. Results No severe complica- tions occurred in both groups, no implant loosening or failure was observed during the follow-up phase. The operation time of the two groups had no statistically significant difference （P 〉 0. 05 ） , the blood loss and length of hospital stay of the anterior cervical steel plate fusion group were less and shorter than the posterior pedicle fixation group[ （103 ±33 ） mL vs （223 ± 38 ） mL, （9 ± 3 ） d vs （ 14 ± 3 ） d ] （ P 〈 0. 01 ）. The Frankle scores of the two groups were improved compared with before treatment, and the posterior pedicle fixation group was better than the anterior cervical steel plate fusion group,with statisti- cally significant difference（ P 〈 0. 05 ）. After treatment, the JOA scores of the two groups were higher than before treatment and the posterior pedicle fixation group was better than the anterior cervical steel plate fusion group, and there were statistically significant differences between groups, time points and groups ± time points （P 〈 0. 01 ）. Conclusion The effect on neurological function recovery of posterior pedicle screw fixation is better than that of the anterior steel plate fixation, and the optimal therapeutic plan should be selected according to the injury type and severity.