经椎弓根伤椎植骨置钉固定与跨伤椎椎弓根置钉固定治疗胸腰椎骨折的疗效比较

Comparison of effects of transpedicular grafting of vertebral pedicle screw and strode over fractured vertebra of vertebral pedicle screw in the treatment of thoracolumbar fractures

目的比较经椎弓根伤椎植骨置钉固定与跨伤椎椎弓根置钉固定治疗胸腰椎骨折的疗效。方法选取威海市中心医院2015年1月至2016年12月收治的胸腰椎骨折患者84例作为研究对象,按照随机数字表法分为两组各42例。对照组采取跨伤椎椎弓根置钉固定治疗,研究组采取经椎弓根伤椎植骨置钉固定治疗,术后均随访12个月。比较两组患者术中出血量、手术时间、术后引流量、骨折愈合时间、住院天数和手术前后椎体前缘压缩比、后凸Cobb角及术后并发症的发生情况。结果两组术后引流量、骨折愈合时间及住院天数差异均无统计学意义(t=1.38、1.79、1.20,均P>0.05),但研究组术中出血量[(183.85±13.88)mL]、手术时间[(119.74±14.85)min]较对照组[(137.97±14.24)mL、(99.46±13.42)min]增加(t=14.95、6.57,均P<0.01)。研究组与对照组术后椎体前缘压缩比[(92.15±8.70)%、(83.75±7.04)%]均明显升高,且术后研究组较对照组升高明显(t=4.86,P<0.01);研究组与对照组术后后凸Cobb角[(10.15±2.47)°、(14.53±4.85)°]较术前均明显下降,且术后研究组较对照组下降明显(t=5.21,P<0.01)。研究组术后并发症发生率为4.76%,与对照组的14.29%比较,差异无统计学意义(χ^2=2.21,P=0.14)。结论经椎弓根伤椎植骨置钉固定在促进胸腰椎骨折患者伤椎复位、矫治后凸畸形及重建椎体高度方面明显优于跨伤椎椎弓根置钉固定,且不会引起严重并发症,具有良好的安全性,因此具有良好的临床应用价值。

Objective To compare the effects of transpedicular grafting of vertebral pedicle screw and strode over fractured vertebra of vertebral pedicle screw in the treatment of thoracolumbar fractures. Methods From January 2015 to December 2016, 84 cases of thoracolumbar fractures in Weihai Central Hospital were randomly divided into two groups according to the digital table, with 42 cases in each group.The control group received strode over fractured vertebra of vertebral pedicle screw, and the study group received transpedicular grafting of vertebral pedicle screw.The patients were followed up for 12 months.The bleeding loss, operation time, postoperative drainage, fracture healing time, hospitalization days and anterior compression ratio of vertebral body, kyphosis Cobb angle before and after treatment and postoperative complications were compared between the two groups. Results There were no statistically significant differences in postoperative drainage volume, fracture healing time and hospitalization days between the two groups (t=1.38, 1.79, 1.20, all P>0.05), but the intraoperative bleeding volume[(183.85±13.88)mL]and operation time[(119.74±14.85)min]in the study group were significantly higher than those in the control group[(137.97±14.24)mL,(99.46±13.42)min](t=14.95, 6.57, all P<0.01). Compared with the control group, the compression ratio of the anterior vertebral body in the study group was significantly increased after operation[(92.15±8.70)% vs.(83.75±7.04)%](t=4.86, P<0.01), and the kyphotic Cobb angle in the study group and the control group were significantly decreased compared with those before operation[(10.15±2.47)°,(14.53±4.85)°], and the postoperative kyphotic Cobb angle in the study group was significantly lower than that in the control group (t=5.21, P<0.01). The incidence rate of postoperative complications in the study group was 4.76%, which showed no statistically significant difference compared with the control group (14.29%,χ^2=2.21, P=0.14). Conclusion Transpedicular grafting of vertebral pedicle screw is superior to strode over fractured vertebra of vertebral pedicle screw in promoting reduction, correcting posterior process deformity and reconstructing vertebral height in patients with thoracolumbar fractures, and it does not cause serious complications, so it has good clinical value.