脊柱后路2种内固定技术治疗胸腰椎爆裂骨折的疗效评估

Clinical evaluation of two types of posterior internal fixation system for treatment of thoracolumbar burst fractures

目的比较KumaFix脊柱后路钉棒系统和传统后路U型钉棒系统短节段内固定治疗胸腰椎爆裂骨折的临床疗效。方法纳入自2011-01—2014-01短节段椎弓根钉内固定联合伤椎椎弓根植骨治疗的120例胸腰椎爆裂骨折,60例采用KumaFix脊柱后路钉棒系统内固定(KumaFix组),60例采用传统后路U型钉棒系统内固定(U型钉组)。结果 120例均获得随访25~60个月,平均35.6个月。末次随访时,KumaFix组9例(15.0%)出现影像学邻近节段退变(ASD),U型钉组29例(48.3%)出现影像学ASD;KumaFix组影像学ASD发生率低于U型钉组,差异有统计学意义(P<0.05)。末次随访时KumaFix组改良Prolo评分为优的例数明显多于U型钉组,差异有统计学意义(P<0.05)。KumaFix组与U型钉组术前、术后即刻、术后1年、末次随访时椎体前缘高度比(AVHR)、矢状位后凸角(KA)和椎管横截面积比值(CSR)比较差异无统计学意义(P>0.05)。结论 KumaFix脊柱后路钉棒系统可以实现椎体渐进、平稳复位,有利于经伤椎椎弓根植骨,降低了邻近节段退变的发生率,是治疗胸腰椎爆裂骨折的有效方法。

Objective To compare the clinical efficacy of KumaFix and traditional U-shaped posterior pedicle screw system in the treatment of thoracolumbar burst fractures. Methods From January 2011 to January 2014, 120 patients with thoraeolumbar burst fracture treated with short segment fixation combined with transpedicular bone graft were enrolled. Sixty cases were treated with KumaFix system（KumaFix group）, while 60 cases were treated with traditional U-shaped pedicle screw system（U-shaped screw group）. Results All patients were followed up from 25 to 60 months, with an average of 35.6 months. At the final follow-up, radiographic adjacent segment degeneration （ASD） was noted in 9 （15.0%） patients in KumaFix group and 29 （48.3%） patients in U-shaped screw group. The incidence of radiographic ASD in KumaFix group was significantly lower than that in U-shaped group （P 〈0.05）. The ratio of best cases of modified Prolo score in KumaFix group was more than U-shaped group, the difference was significant （P 〈0.05）. There were no significant difference between the two groups in the average vertebral height ratio（AVHR）, sagittal kyphotic angle（KA） and spinal canal cross-sectional area ratio（CSR） in any time of follow-up. Conclusion Compared with traditional U-shaped pedicle screw, KumaFix fixation system can achieve gradually, controlled reduction, provide enough space for bone implantation, and avoid acceleration of adjacent segment degeneration. It is an effective and reliable technique to treat thoracolumbar burst fractures.