腰椎椎体压缩性骨折不同固定节段的临床疗效分析

Comparison of the clinical effects of different fixation segments for vertebral compression fractures

目的:探讨腰椎椎体压缩性骨折不同固定节段对疗效的影响。方法:回顾性分析2012年7月~2016年7月我科采用后路经椎弓根钉棒系统固定治疗的腰椎椎体压缩性骨折患者36例,其中男20例,女16例,年龄32~65岁,平均(40.5±4.5)岁,经影像学检查为新鲜椎体压缩性骨折,所有患者均单纯行椎弓根内固定不行后路椎管减压,固定节段为单节段、双节段、三节段固定;对比3组患者手术切口长度、术中出血量、手术时间、术后伤口引流量等指标及手术前后椎体前缘压缩率、矢状位Cobb角、内固定失败率、术后并发症,评估临床效果。结果:所有患者均顺利完成手术,无死亡、大血管损伤和截瘫等严重并发症发生。32例获随访,随访时间10~12个月,平均(11.6±2.4)个月。单节段固定组手术切口长度较短、术后伤口引流量较少,与其他2组比较差异有统计学意义(P<0.05),三节段固定组手术时间较长,术中出血量较多,与其他2组比较差异有统计学意义(P<0.05)。三节段固定组矢状位Cobb角、术后及拆钉前椎体前缘压缩率均优于其他2组,差异有统计学意义(P<0.05)。双节段固定组有1例发生断钉。结论:腰椎椎体压缩性骨折不同固定节段对疗效有一定影响,需根据患者实际情况选择。

Objective： To evaluate the efficacies and outcomes of different fixation segments in treatment of lumbar vertebral compression fractures. Methods ： The clinical data were retrospectively analyzed in 36 cases of vertebral compression fractures treated by posterior internal fixation with pedicle screw in our department between July of 2012 and 2017. In the 36 patients, 20 were males and 16 females. The age ranged from 32 to 65 years, with mean age of （40.5±4.5） years. Radiology indicated that all cases were fresh vertebral compression fractures. Treatment included pedicle screw fixation without spinal canal decompression, and fixation included single segments, two segments and three segments in all patients. The clinical outcomes were compared regarding the incision size, intraoperative blood loss, operative time, postoperative drainage volume as well as changes of vertebra height at the posterior margin and Cobb＇angle at sagittal view before and after operation, internal fixation failure, and postoperative complications among the three groups. Results： The operation was successfully completed in all patients, with no death, damage to the great vessels and paraplegia. The 32 patients were followed up for 10 to 12 months[ mean： （11.6±2.4）months]. The perioperative indicators was statistically different, and patients treated with single segment fixation had smaller incision size and postoperative drainage volume （P〈0.05）. Patients treated with three segment fixation had longer operative time and larger intraoperative blood loss, yet better improvement of Cobb angle and anterior vertebra margin than those managed with single or two-segment fixation （P〈0.05）. Pedicle screw breakage occurred in one patient treated with two-segment fixation. Conclusion： Different segment fixation for lumber compression fracture may have different outcomes, suggesting that the operative options should be decided on the patient＇s condition basis.