后路固定融合与非融合治疗胸腰椎爆裂骨折的对比研究

Comparative study of posterior fixed fusion and non-fusion for the treatment of thoracolumbar burst fractures

目的对比研究胸腰椎爆裂骨折行单纯后路复位椎弓根螺钉内固定术及后路椎弓根钉内固定结合椎板间和小关节突间融合术治疗后的临床疗效。方法 148例胸腰椎爆裂骨折患者,根据治疗方法不同分为非融合组(93例)与融合组(55例)。非融合组行单纯后路复位椎弓根螺钉内固定术治疗,融合组行后路椎弓根钉内固定结合椎板间和小关节突间融合术治疗。对比两组手术时间、出血量、术前Cobb角、术后Cobb角、终末随访Cobb角、术前椎体前缘高度、术后椎体前缘高度、终末随访椎体前缘高度及平均随访时间,记录内固定物取出情况等。结果非融合组患者手术时间为(90±16)min,明显短于融合组的(116±23)min,差异具有统计学意义(P<0.05);非融合组患者出血量(236±14)ml与融合组的(241±26)ml比较差异无统计学意义(P>0.05)。非融合组患者术前Cobb角为(22.9±10.6)°,术后Cobb角为(9.2±1.4)°,终末随访Cobb角为(11.2±3.4)°,术前椎体前缘高度为(12.10±3.60)mm,术后椎体前缘高度为(23.70±4.00)mm,终末随访椎体前缘高度为(23.00±4.20)mm;融合组患者术前Cobb角为(22.1±7.6)°,术后Cobb角为(9.4±1.3)°,终末Cobb角为(11.4±2.7)°,术前椎体前缘高度为(12.50±3.20)mm,术后椎体前缘高度为(23.35±3.90)mm,终末随访椎体前缘高度为(23.10±4.00)mm;两组患者术前Cobb角、术后Cobb角、终末随访Cobb角、术前椎体前缘高度、术后椎体前缘高度、终末随访椎体前缘高度比较差异无统计学意义(P>0.05)。两组患者终末随访时无内固定断裂和椎弓根螺钉拔出。非融合组患者随访18～38个月,平均随访(26±2)个月,融合组患者随访19～36个月,平均随访(25±5)个月,两组患者平均随访时间比较差异无统计学意义(P>0.05)。两组患者均取出内固定物,非融合组局部节段运动恢复良好。结论对于无需减压的胸腰椎爆裂骨折而言,采用经后路椎弓根内固定术后无需常规融合,内定物取出后,非融合技术可保留局部的运动节段。

Objective To compare and study the clinical efficacy of posterior reduction and pedicle screw internal fixation and posterior pedicle screw internal fixation combined with interlaminar and facet fusion in the treatment of thoracolumbar burst fractures. Methods A total of 148 patients with thoracolumbar burst fractures were divided by different treatment methods into non-fusion group(93 cases) and fusion group(55 cases).Non-fusion group was treated with posterior reduction and pedicle screw internal fixation, and fusion group was treated with posterior pedicle screw internal fixation combined with interlaminar and facet fusion. Comparison were made on operation time, bleeding volume, preoperative Cobb angle, postoperative Cobb angle, final follow-up Cobb angle, preoperative anterior vertebral height, postoperative anterior vertebral height, final follow-up vertebral anterior height and mean follow-up time in two groups, and the removal of internal fixator was recorded. Results Non-fusion group had obviously shorter operation time as(90±16) min than(116±23) min in fusion group, and the difference was statistically significant(P<0.05). Non-fusion group had no statistically significant difference in bleeding volume as(236±14) ml, comparing with(241±26) ml in fusion group(P>0.05). Non-fusion group had preoperative Cobb angle as(22.9±10.6) °, postoperative angle as(9.2±1.4) °, final follow-up vertebral anterior height as(11.2±3.4)°, preoperative anterior vertebral height as(12.10±3.60) mm, postoperative anterior vertebral height as(23.70±4.00) mm, final follow-up vertebral anterior height as(23.00±4.20) mm. Fusion group had preoperative Cobb angle as(22.1±7.6)°, postoperative angle as(9.4±1.3)°, final follow-up vertebral anterior height as(11.4±2.7)°, preoperative anterior vertebral height as(12.50±3.20) mm, postoperative anterior vertebral height as(23.35±3.90) mm, final follow-up vertebral anterior height as(23.10±4.00) mm. Both groups had no statistically significant difference in preoperative Cobb angle, postoperative Cobb angle, final follow-up Cobb angle, preoperative anterior vertebral height, postoperative anterior vertebral height, final follow-up vertebral anterior height(P>0.05). There were no internal fixation fractures and pedicle screw extraction at the final followup of the two groups. Non-fusion group had follow-up time as 18~38 months, with mean follow-up time as(26±2) months, and fusion group had follow-up time as 19~36 months, with mean follow-up time as(25±5) months. Both groups had no statistically significant difference in mean follow-up time(P>0.05). The internal fixator was removed in both groups, and the local segmental motion recovered well in the non-fusion group. Conclusion For thoracolumbar burst fractures without decompression, there is no need for conventional fusion after posterior pedicle fixation. After removal of the internal fixator, the non-fusion technique can preserve the local motion segments.