后路半椎板不同减压短节段椎弓根螺钉内固定治疗胸腰椎爆裂骨折的临床疗效

Clinical Efficacy of Posterior Decompression with Different Laminectomy and Short Segment Pedicle Screw Fixation in Treatment of Thoracolumbar Burst Fracture

目的:探究后路半椎板不同减压方式、短节段椎弓根螺钉内固定治疗胸腰椎爆裂骨折的临床疗效。方法:选择北京朝阳急诊抢救中心收治的42例胸腰椎爆裂骨折患者作为研究对象,根据手术方式的不同分为直接减压组(21例)、间接减压组(21例),CT检测手术前后伤椎前缘、后缘高度百分比变化、后弓畸形角(Cobb角)、伤椎横截面积以及上、下位椎管横截面积,计算椎管侵占率。改良Frankel分级法对手术前后患者神经功能恢复情况进行评定,Denis疼痛分级评定、Oswestry功能障碍指数评定法分别对患者患者腰痛情况、腰背功能恢复情况进行评定,对比两组术后并发症发生情况。结果:两组患者术后伤椎前缘高度比例、后缘伤椎高度比例均升高,Cobb角度、椎管侵占率降低,差异有统计学意义(P<0.05)。术后两组患者神经功能均得到改善,Frankel级别相比,差异有统计学意义(P<0.05),组间对比,差异无统计学意义(P>0.05)。两组患者术后腰部疼痛均有所缓解,手术前后Denis疼痛等级对比,差异有统计学意义(P<0.05)。间接减压组Oswestry功能障碍总分高于直接减压组,总发生率低于直接减压组,差异有统计学意义(P<0.05)。结论:后路半椎板减压、短节段椎弓根螺钉内固定是治疗胸腰椎爆裂骨折的有效方法,与直接减压方式相比,间接减压患者术后腰椎功能恢复更好,且并发症发生率低,安全性较高。

Objective:To explore clinical efficacy of posterior decompression with different laminectomy and short segment pedicle screw fixation in treatment of thoracolumbar burst fracture.Methods:42 cases of patients with thoracolumbar burst fracture treated in Beijing Chaoyang emergency center were selected as the study objects.According to different surgical methods,all the patients were divided into direct decompression group(21 cases)and indirect decompression group(21 cases).The percentage changes of the anterior and posterior edge of the injured vertebra,the deformity angle of posterior arch(Cobb angle),cross-sectional area of injured vertebra and cross-sectional area of the upper and lower vertebral canal were detected by CT,and vertebral canal invasion rate was calculated.Modified Frankel grading method was used to evaluate the recovery of neurological function before and after operation,and low back pain and recovery of back function were evaluated by using Denis grading of pain and Oswestry dysfunction index evaluation method.Postoperative complications of the two groups were compared in the two groups.Results:The proportion of the leading edge of injured vertebra,the height of posterior injury and vertebral height increased,and Cobb angle and the rate of vertebral canal invasion decreased in the two groups,with statistically significant difference(P<0.05).Neurological function of the two groups improved after operation,and there was significant difference in Frankel grade(P<0.05).There was no significant difference between the two groups(P>0.05).Waist pain relieved in the two groups,and there was statistically significant difference in Denis pain grade before and after operation(P<0.05).Total score of Oswestry dysfunction in indirect decompression group was higher than that in direct decompression group,and the total incidence rate was lower than that in direct decompression group,with statistically significant difference(P<0.05).Conclusion:Posterior decompression through laminectomy and short segment pedicle screw fixation is an effective treatment for thoracolumbar burst fractures,and compared with the direct decompression,postoperative lumbar function recovery of patients with indirect decompression is better,and complication rate is low,with higher safety.