经伤椎椎弓根置钉固定治疗A型胸腰椎骨折疗效分析

Clinical efficacy of pedicle screws fixation via injured vertebral pedicle in treatment of type A thoracolumbar fracture

目的探讨经伤椎置钉椎弓根螺钉系统固定治疗A型胸腰椎骨折的临床疗效。方法自2013年1月至2015年6月,采用经伤椎及伤椎上下节段椎弓根内固定治疗A型胸腰椎骨折患者25例。比较术前与术后1w、术后3、12个月伤椎前缘高度比(FVHR)、矢状面后凸Cobb角矫正情况以及疼痛视觉模拟评分(VAS)改善情况,并观察内固定物有无松动断裂。结果 25例患者均获得随访,平均随访时间(14.3±2.1)个月。与术前比较,术后1w、3、12个月伤椎前缘高度比(FVHR)、矢状面Cobb角及VAS评分相互比较,可以发现有明显改善,差异具有统计学意义(P<0.05),术后3次复查之间无统计学意义(P>0.05);无内固定松动及断裂。结论经伤椎椎弓根置钉固定治疗A型胸腰椎骨折,复位效果好,内固定稳定,并发症少,值得临床推广应用。

Objective To evaluate the clinical efficacy of pedicle screws fixation via the injured vertebral pedicle in the treatment of type A thoracolumbar fracture.Methods Twenty-five cases of type A thoracolumabr vertebral fractures treated with pedicle screw fixation via the injured vertebral pedicle and vertebral body upper and lower segment pedicle were retrospectively analyzed from January 2013 to June 2015.Observation was conducted to investigate the anterior vertebral height ratio（FVHR）and Cobb angle,improved result in visual analogue scale（VAS）within 1 week,3 months and 12 months after the operation,and whether the internal fixation was loosen or broken.Results All 25 patients achieved（14.3±2.1）months follow-up.The anterior vertebral height ratio（FVHR）,Cobb angle and VAS score were significantly improved after operation（P〈0.05）.There was no remarkable difference in FVHR Cobb angle and VAS score among 3 times follow-up（P〈0.05）.No fixations were loosen or broken.Conclusion For treating type A thoracolumbar fractures,transpedicular fixation via the injured vertebrae can effectively reduce the injured vertebral height,provide stable fixation,reduce complications,and is worthy of clinical application.