经后路不同伤椎置钉内固定术在胸腰段骨折治疗中的临床效果比较

Different posterior injured vertebra transpedicular fixations in management of thoracolumbar fractures

目的比较经后路不同伤椎置钉内固定术治疗胸腰段骨折的临床疗效。方法通过回顾性分析的方法,对48例胸腰段骨折患者进行分组分析。分为短节段跨伤椎置钉组(A组)17例,短节段伤椎置钉组(B组)20例,单节段伤椎固定组(C组)11例。比较三组的手术时间、术中出血量及伤椎Cobb角度的矫正情况。结果 C组的手术时间最短,出血量最少(P<0.05)。经随访,B组在术后椎体压缩率及Cobb角变化与末次随访相比变化较少(P<0.05),而A组与C组比较差异无统计学意义(P>0.05)。结论三种术式均可有效恢复椎体高度,恢复脊柱的稳定性。短节段伤椎置钉在维持患椎高度丢失及稳定Cobb角上优于其他两种手术方式。单节段伤椎置钉疗效相仿,同时创伤较小,手术时间短,出血量少,是值得选择的手术方法之一。

Objective To compare the curative effects of posterior pedicle different intermediate screws internal fixation and spinal fixation on thoracolumbar fractures. Methods The data of 48 thoracolumbar fracture patients were retrospectively analyzed. There were divided into three groups according to different operation methods： Shortsegment pedicle instrumentation group（group A, n=17）, intermediate screws group（group B, n=20）, monosegment pedicle instrumentation group（group C, n=11）. The operative time and intraoperative blood loss, follow-up wounded vertebral Cobb Angle correction and the postoperative complications were compared among the three groups. Results Among the three groups, the operative time and blood loss in group C were the least（P〈0.05）. After the last follow-up visit, the correction of the fracture vertebra cobb angles in group B was significantly better than that in group A or group C（P〈0.05）, but there was no significant difference between group A and group C（P〉0.05）. Conclusion The three operative methods can all effectively fix the vertebral body and restore the stability of the spine. Intermediate screws are better than the other two kinds of operation methods in stabilizing vertebral height loss and cobb angles. The effect of monosegment pedicle instrumentation is equal to that of shortsegment pedicle instrumentation, but has advantages of less trauma, shorter operation time and less blood loss.