短节段内固定联合椎体成形术治疗胸腰椎骨折的临床效果

Effect of short-segment pedicle instrumentation combined with vertebroplasty on patients with fractures of thoracolumbar spine

目的 探讨短节段内固定（SSPI）联合椎体成形术（VP）治疗胸腰椎骨折的临床效果。方法 选取2013年1月至2016年12月在上海市第八人民医院就诊的胸腰椎骨折患者70例，采用随机数字表法分为单纯内固定治疗组和联合治疗组（SSPI＋VP），每组35例。比较2组患者的切口长度、术中出血量、手术时间、住院时间和住院费用、治疗前后椎管侵占率、Cobb角以及伤椎前缘高度比值变化和治疗效果。结果 2组患者切口长度、住院时间及住院费用比较，差异无统计学意义（P＞0.05），联合治疗组患者术中出血量明显多于、手术时间明显长于单纯内固定治疗组［（260±16）ml比（237±11）ml、（116±14）min比（103±13）min］（P＜0.001）。治疗后，联合治疗组患者的椎管侵占率、Cobb角较单纯内固定治疗组更低，伤椎前缘高度比值较单纯内固定治疗组更高（P＜0.05）。联合治疗组的疗效明显优于单纯内固定治疗组［94.3%（33/35）比74.3%（26/35）］（Z=-3.685，P＜0.05）。结论 SSPI联合VP治疗胸腰椎骨折的疗效确切，其可重建脊柱的生物力学，维持伤椎高度，稳定脊柱结构。

Objective To observe the effect of short-segment pedicle instrumentation（SSPI） combined with vertebroplasty（VP） on patients with fractures of thoracolumbar spine. Methods Totally 70 patients with thoracolumbar fractures were enrolled from January 2013 to December 2016 in Shanghai Eighth People′s Hospital; the patients were randomly divided into SSPI group and SSPI＋VP group, with 35 cases in each group. Incision length, intraoperative blood loss, operation duration, hospitalization duration and costs were recorded. Spinal canal encroachment rate, Cobb angle and anterior height ratio of injured vertebra were analyzed. Results Incision length, length of hospital stay and hospitalization costs had no significant differences between groups（P〉0.05）. Intraoperative blood loss in SSPI＋VP group was significantly more and operation duration was significantly longer than those in SSPI group[（260±16）ml vs （237±11）ml, （116±14）min vs （103±13）min]（P〈0.001）. After treatment, the spinal canal encroachment rate and Cobb angle in SSPI＋VP group were significantly lower and the injured vertebral anterior height ratio was significantly higher than those in SSPI group（P〈0.05）. The curative effective rate in SSPI＋VP group was significantly higher than that in SSPI group[94.3%（33/35） vs 74.3%（26/35）]（Z=-3.685, P〈0.05）. Conclusion The efficacy of SSPI combined with VP is definite in curing thoracolumbar fractures with reconstruction of biomechanics, maintaining of vertebral height and stabilization of spinal structure.