单侧与双侧经伤椎短节段固定治疗伴单侧椎弓根骨折胸腰椎骨折的疗效比较

Comparison of clinical efficacy of unilateral and bilateral short segment transpedicular fixation in treating thoracolumbar fractures combined with unilateral pedicle fractures

目的 比较单侧与双侧经伤椎固定联合短节段固定治疗伴单侧椎弓根骨折的胸腰椎骨折临床疗效。 方法采用回顾性病例对照研究分析2012年1月-2016年12月绍兴市人民医院收治的43例伴单侧椎弓根骨折胸腰椎骨折患者临床资料，其中男24例，女19例；年龄19-68岁，平均48岁。损伤节段T101例，T116例，T1211例，L1 19例，L26例。根据手术方式分为单侧经伤椎固定组（单侧组，15例）和双侧经伤椎固定组（双侧组，28例）。均采用经伤椎固定联合短节段固定治疗。比较两组手术时间、术中出血量、术中透视次数、骨折愈合时间、内固定拆除时间、术前术后伤椎前缘高度比、椎体矢状位Cobb角恢复情况、椎管侵占率、视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）、脊髓损伤Frankel分级，以及伤椎螺钉偏移发生率、脊柱侧方成角等。 结果患者均获随访12-26个月，平均18．5个月。单侧组和双侧组手术时间分别为（82．3±14．7）min和（120．9±12．8）min，术中出血量分别为（186．1±20．4）ml和（231．2±39．6）ml，术中透视次数分别为（6．6±1．2）次和（13．3±2．0）次，伤椎螺钉偏移发生率分别为13％（2／15）和46％（26／56）（P均〈0．05）。骨折愈合时间、内固定拆除时问、末次随访伤椎前缘高度比、椎体矢状位Cobb角、椎管侵占率、脊柱侧方成角、VAS、ODI及Frankel分级比较，两组差异均无统计学意义（P〉0．05）。 结论对于伴单侧椎弓根骨折的胸腰椎骨折，单侧经伤椎固定联合短节段固定具有与双侧经伤椎短节段固定相似的复位与固定效果，且单侧经伤椎短节段固定具有手术时间短、出血少、透视次数少、伤椎螺钉偏移率低等优势。

Objective To compare the clinical efficacy of unilateral and bilateral short segment fixation in treating thoracolumbar fractures combined with unilateral pedicle fractures. Methods A retrospective case control study was conducted on the clinical data of 43 patients with thoraeolumbar fractures with unilateral pedicle fractures admitted from January 2012 to December 2016. There were 24 males and 19 females, with a mean age of 48 years （range, 19-68 years）. Fractured segments included W10 in 1 patient, T11 in 6, T12 in 11, L1 in 19, and L2 in 6. According to the fixation method,the patients were divided into unilateral transpedicular fixation group （unilateral group, 15 patients） and bilateral transpedicular fixation group （bilateral group, 28 patients ）. All patients were treated with fixation via injured vertebrae combined with short segment fixation. The operation time, intraoperative blood loss, X-ray frequency, fracture healing time, internal fixation removal time, preoperative and postoperative anterior vertebral height ratio, sagittal Cobb angle recovery, spinal canal invasion rate, visual analogue score （VAS） , Oswestry dysfunction index （ODI） , Frankel classification of spinal cord injury, incidence of screw deviation, and spinal lateral angulation were compared between the two groups. Results All patients were followed up for 12-26 months, with an average of 18.5 months. The operation time in unilateral group and bilateral group were （82.3 ± 14.7 ） minutes and （ 120.9 ± 12. 8 ） minutes, respectively. The intraoperative blood loss was （186. 1 ±20.4）ml in unilateral group and （231.2 ± 39.6） ml in bilateral group. The number of fluoroscopy was （6.6 ± 1.2） times in unilateral group and （ 13.3 ±2.0）times in bilateral group respectively. The incidence of screw deviation was 13% （2/15） in unilateral group and 46% （26/56） in bilateral group （P 〈0.05）. There were no significant differences between the two groups in anterior vertebral height ratio, sagittal Cobb angle, spinal canal invasion rate, VAS, ODI, Frankel grade and spinal lateral angulation （P 〉 0.05）. Conclusions For thoracolumbar fractures combined with unilateral pedicle fractures, unilateral and bilateral transpedicular short segment fixation has similar reduction and fixation effects. Unilateral transpedicular short segment fixation has the advantages of shorter operation time, less bleeding, fewer fluoroscopy times, and lower screw deviation rate.