经后外单侧入路椎体次全切融合钉棒固定治疗胸腰椎爆裂性骨折的临床疗效观察

Clinical observation of posterior lateral unilateral total vertebral body fusion and pedicle screw fixation for treatment of thoracolumbar burst fractures

目的探讨经后外单侧入路椎体次全切植骨融合钉棒固定术治疗胸腰椎爆裂性骨折的临床疗效。方法唐山市人民医院2014年1月—2016年3月收治41例Denis B型胸腰椎爆裂性骨折患者,男性29例,女性12例;年龄31~59岁,平均43.5岁。按照采取的手术方式不同分为后外单侧入路组(23例)和侧前方入路组(18例)。比较两组患者手术时间、术中出血量、术后引流量、临床疗效及并发症发生率。结果后外单侧入路组手术时间(181.66±21.47)min,术中出血量(614.84±111.75)mL,术后引流量(286.84±61.79)mL;侧前方入路组手术时间(177.53±19.82)min,术中出血量(627.88±134.20)mL,术后引流量(279.66±62.48)mL。两组比较差异无统计学意义(P>0.05)。后外单侧入路组临床总有效率为95.65%,侧前方入路组临床总有效率为72.22%,差异有统计学意义(P<0.05)。后外单侧入路组并发症发生率为8.69%;侧前方入路组为5.56%,两组比较差异无统计学意义(P>0.05)。结论在治疗胸腰椎爆裂性骨折方面,经后外单侧入路椎体次全切植骨融合钉棒固定疗效显著,值得临床推广。

Objective To investigate the clinical effects of trans-vertebral subtotal vertebral body fusion and pedicle screw fixation in the treatment of thoracolumbar burst fractures.Methods Forty-one patients(29 males and 12 females aged from 31 to 59 years)with Denis B-type thoracolumbar burst fractures were treated in Tangshan People s Hospital from Jan.2014 to Mar.2016.According to the different surgical methods,they were divided into the posterior unilateral approach group(23 cases)and anterior-lateral approach group(18 cases).Surgical indicators,clinical efficacy,postoperative recovery and the incidence of complications were observed in the two groups.Results The operative time was(181.66±21.47)min,the intraoperative blood loss was(614.84±111.75)mL and the postoperative drainage volume was(286.84±61.79)mL in the posterior unilateral approach group and(177.53±19.82)min,(627.88±134.20)mL and(279.66±62.48)mL in the anterior-lateral approach group,respectively.There was no significant difference between the two groups(P>0.05).The total effective rate was 95.65%in the unilateral approach group and 72.22%in the anterior approach group,and the difference was statistically significant(P<0.05).The incidence of postoperative complication rate was 8.69%in the posterior unilateral approach group and 5.56%in the anterior lateral approach group,and the difference was not statistically significant(P>0.05).Conclusion The posterior unilateral total vertebral body fusion and pedicle screw fixation is effective in treating thoracolumbar burst fractures and is worthy of clinical promotion.