经后路椎弓根螺钉固定节段不同数目对AO-C型胸腰椎骨折脱位疗效影响

Influence of number of fixed segments in patients with AO-C type thoracolumbar fracture and dislocation treated with posterior pedicle screw internal fixation

目的探究经后路椎弓根螺钉固定节段数目不同对AO-C型胸腰椎骨折脱位疗效的影响。方法2013年1月—2016年6月洛阳正骨医院收治AO-C型胸腰椎骨折脱位(II度及以上)患者90例,按随机数字表法分为观察组和对照组各45例,观察组给予8枚椎弓根螺钉4节段内固定治疗,对照组给予6枚椎弓根螺钉3节段内固定治疗,比较两组手术一般资料、神经功能恢复情况、术后伤椎高度比值和后凸Cobb角、手术疗效及术后并发症情况。结果两组手术时间、术中出血量和术后住院时间比较差异均无统计学意义(P>0.05)。术后1周两组伤椎高度比值和后凸Cobb角比较差异无统计学意义(P>0.05);术后12个月时,观察组伤椎高度比值大于对照组,后凸Cobb角小于对照组(P<0.05),观察组脱位复位的比例和治疗有效率及神经功能恢复情况均优于对照组(P<0.05)。结论对于II度及以上的AO-C型胸腰椎骨折脱位,与6枚椎弓根螺钉3节段固定相比,8枚椎弓根螺钉4节段固定在脊柱整体稳定性、神经功能恢复和脱位复位效果方面优势明显,值得临床推广。

Objective To explore the influence of number of fixed segments on effects of patients with AOC type thoracolumbar fracture and dislocation treated with posterior pedicle screw internal fixation. Methods Totally 90 patients with AO-C type thoracolumbar fracture and dislocation（ II degree and above） treated in our hospital from Jan. 2013 to Jun. 2016 were selected. They were divided into observation group（ 45 cases） and control group（ 45 cases）. The observation group was given pedicle screw fixation（ 8 screws,4 segments）; while the control group was given pedicle screw fixation（ 6 screws,3 segments）. The clinical data such as general condition,neurological function recovery,vertebral height compression ratio,Cobb angle,surgical effect and complications was compared between the two groups. Results There was no significant difference in operation time,blood loss and postoperative hospital stay between the two groups（ P 0. 05）. There was no significant difference in vertebral height compression ratio and Cobb angle between the two groups one week after surgery（ P 0. 05）; the vertebral height compression ratio of the observation group was higher than that of the control group,and the Cobb angle of the observation group was lower than that of the control group（ P 0. 05）. The proportion of reduction,efficiency of treatment and recovery of neurological function of the observation group was higher than those of the control group（ P 0. 05）. Conclusion For AOC type thoracolumbar fracture and dislocation of type II and above,8 screws and 4 segments can provide more overall stability of spine compared with pedicle screw fixation with 6 screws and 3 segments.