经伤椎置钉手术治疗单节段胸腰椎骨折的临床研究

Clinical Study on 40 Cases of Monosegmental Fixation for the Treatment of Single Thoracolumbar Vertebral Fracture

目的探讨经伤椎置钉手术治疗单节段胸腰椎骨折患者的临床效果。方法选取2012年1月至2015年7月我院接诊的单节段胸腰椎骨折患者80例,采用随机数字表法分为两组,每组各40例。对照组患者给予后路短节段椎弓根钉跨伤椎内固定术治疗,观察组给予经伤椎置钉手术治疗。比较两组患者治疗手术参数以及治疗后的Cobb角、椎体压缩百分比、椎管矢状径占位率、神经功能障碍恢复,对比术后1年内固定失败率。结果两组患者的手术时间、住院时间以及失血量进行比较,差异无统计学意义(P>0.05);观察组患者的Cobb角、椎体压缩百分比及椎管矢状径占位率为(4.56°±0.78°、12.45±1.02、4.58±0.23),明显低于对照组患者(6.78°±1.02°、16.47±2.98、6.85±0.49),差异具有统计学意义(P<0.05);术后,患者的神经功能障碍分级均有改善,两组对比,差异无统计学意义(P>0.05);治疗后,观察组患者术后1年内固定总失败率为2.5%,低于对照组患者的17.5%,差异具有统计学意义(P<0.05)。结论单节段胸腰椎骨折选用经伤椎置钉手术治疗,可提高远期固定效果,降低椎体坍塌、内固定失败的发生,促进患者术后早期康复。

Objective To investigate the clinical effect of monosegmental fixation for the treatment of single thoracolumbar vertebral fracture. Methods 80 cases with single thoracolumbar vertebral fracture were selected from January 2012 to July 2015 in our hospital. All the single thoracolumbar fracture patients were randomly divided into two groups,with 40 patients in each. The patients in the observation group received pedicle screw fixation via the monosegmental vertebra and the patients in the control group were treated with posterior short segment pedicle screw fixation across the injured vertebra. The surgical parameters,such as the Cobb angle,the percentage of vertebral compression,the sagittal diameter of vertebral canal and the recovery of neurological deficits were compared between the two groups. The rate of fixation failure in one year after operation was compared as well. Results Operation time,length of hospital stay and intra-operative blood loss of the two groups were compared,and the difference was not statistically significant（P〉0. 05）. The Cobb angle vertebral compression percentage and sagittal diameter of spinal canal occupying rate of the observation group was significantly lower than that of control group,which was（4. 56° ± 0. 78°,12. 45 ± 1. 02,4. 58 ± 0. 23） VS（6. 78° ± 1. 02°,16. 47 ± 2. 98,6. 85 ± 0. 49）. The differences were statistically significant（P〈0. 05）. The neurological function of the patients improved,and there was no significant difference between the two groups（P〉0. 05）. The total failure rate of the observation group within one year was 2. 5%,which was lower than 17. 5% of the control group,and the difference was statistically significant（P〈0. 05）. Conclusion It can improve long-term fixation effect,reduce vertebral collapse and the internal fixation failure rate,and promote early postoperative rehabilitation of the pedicle screw fixation via the injured vertebra for the treatment of single thoracolumbar vertebral fracture.