不同固定方式治疗胸腰椎骨折的近期疗效观察

Curative effect observation of different fixation methods for thoraco-lumbar fracture

目的后路经伤椎椎弓根钉固定方式与跨伤椎椎弓根钉内固定治疗胸腰段椎骨折临床效果观察,探讨胸腰椎骨折不同固定方式的可行性及有效性。方法回顾分析2012年9月~2015年9月83例胸腰椎骨折患者的资料,分别采用跨伤椎椎弓根螺钉固定44例,经伤椎椎弓根螺钉固定39例,其中男性48例,女性35例,平均年龄42.5岁。观察对比术前、术后、术后12、18个月时Cobb角及伤椎前后缘高度的变化情况。结果所有患者术后随访12~24个月,平均17.6个月。术后两组患者矫正度均存在丢失现象,术后12、18个月时椎体前缘高度及椎体后缘高度变化方面两组间比较无统计学差异(P>0.05)。两组间Cobb角矫正度丢失率有统计学差异(P<0.05),跨伤椎固定组术后12个月时的Cobb角与术后比较差异有统计学意义(P<0.05),经伤椎固定组术后12个月时的Cobb角与术后比较差异无统计学意义(P>0.05);跨伤椎固定组术后18个月时的Cobb角与术后比较差异有统计学意义(P<0.05),经伤椎固定组术后18个月时的Cobb角与术后比较差异无统计学意义(P>0.05)。结论经伤椎固定组与跨伤椎固定组,均能改善椎体前缘高度比和Cobb角,本文中经伤椎固定组能够更好地维持脊柱矫正度,是胸腰椎骨折经后路治疗中较好的选择。

Objective to posterior vertebral pedicle screw fixation and observed inter vertebral pedicle screw fixation in treatment of thoracolumbar vertebral fractures of thoracolumbar fracture clinical effect, feasibility and effectiveness of different fixation methods. Methods Retrospective analysis of Sep 2012 to Sep 2015 83 cases of thoracolumbar fracture patients, using inter vertebral pedicle screw fixation in 44 cases, vertebral pedicle screw fixation in 39 cases, there were 48 males and 35 females, the average age of 42.5 years. Preoperative and postoperative （7 days）, 12, 18 months after the Cobb angle and the height of the anterior and posterior margin of the injured vertebra were observed and compared. Results All patients were followed up for 12 to 24 months with an average of 17.6 months. There was no significant difference between the two groups in the two groups after operation, the height of the leading edge of the vertebral body and the height of the posterior edge of the vertebral body in 12 and 18 months after operation, there was no significant difference between the groups（P〉0.05）. Between the two groups Cobb angle correction loss rate was statistically difference（P〈0.05）, the across vertebral fixation group 12 months after operation the Cobb angle and the 7 day after surgery the difference was statistically significant（P〈0.05）, with Cobb at 12 months postoperative vertebral fixation group and operation angle after 7 days compared with no significant difference（P〉0.05）; the across vertebral fixation group 18 months after operation the Cobb angle and the 7 day after surgery the difference was statistically significant（P〈0.05）, with Cobb at 18 months postoperative vertebral fixation group angle and postoperative day 7 there was no significant difference（P〉0.05）. Conclusion Vertebral fixation group and across vertebral fixation group, can improve the ratio of anterior vertebral height and Cobb angle, and in this paper, vertebral fixation group has better effect on maintaining the spinal correction, is the better choice for posterior thoracic and lumbar fractures treatment.