椎弓根螺钉长节段固定与短节段固定治疗胸腰段脊柱骨折的临床研究

Clinical Study on the Treatment of Thoracolumbar Spine Fracture with Pedicle Screw Long Segment Fixation and Short Segment Fixation

目的:探讨胸腰段脊柱骨折采用后路椎弓根螺钉长节段内固术与短节段内固定术之间的临床疗效对比。方法:回顾性的选取自2014年3月至2016年5月在广西中医药大学第一附属医院院综合骨科住院并进行手术治疗的80名资料完整的胸腰段脊柱骨折患者的临床资料,随访时间段2016年2月至2017年7月(平均15.5个月),以及对两手术组的术中时间、手术前后、术后1周及术后3个月的椎体前缘高度(%)、Cobb角(°)、最后一次随访矫形丢失度情况进行回顾性对比分析。结果:所观察的80名患者均得到随访且无受试者死亡或者失联,其中长节段内固定有38名患者,短节段内固定有42名患者。但有1例出现断棒(长节段组),1例出现断钉、有6例出现螺钉松动及移位情况(短节段组)。术后立即透视及术后1周拍片检查显示Cobb角(°)、椎体前缘高度(%)之间进行对比,差异无统计学意义(P>0.05)。术后3个月再次对手术的80名患者逐一随访发现,长节段内固定与短节段内固定的Cobb角(°)、椎体前缘高度(%)、矫正度丢失情况进行对比,差异具有统计学意义。结论:经后方入路短节段内固定与长节段内固定在治疗胸腰段脊柱骨折方面都具有非常显著的效果,术中均能得到很好的复位及畸形矫正,但短节段组椎弓根内固定系统容易出现矫正度丢失、螺钉松动或移位、椎体前缘高度(%)再次发生丢失以及Cobb角(°)再次增加等情况。

Objective:To investigate the clinical efficacy of posterior pedicle screw fixation and short segmental internal fixation in the treatment of thoracolumbar spine fractures.Methods:The clinical data of 80 patients with complete thoracolumbar spine fractures who underwent surgery and surgery in our hospital from March 2014 to May 2016 were retrospectively selected.The follow-up period was February 2016 to July 2017(average 15.5 months),and the intraoperative time,preoperative and postoperative height(%),Cobb angle(°)and the last follow-up loss of orthosis of the two groups were analyzed retrospectively.Results:All 80 patients were followed up and no subjects died or lost.Among them,38 patients were fixed in long segment and 42 patients were fixed in short segment.However,there were 1 case of broken rods(long segment group),1 case of broken nails,6 cases of screw loosening and displacement(short segment group).Immediate postoperative fluoroscopy and 1 week postoperative examination showed Cobb angle(°)and vertebral body height(%)were compared,the difference was not statistically significant(P>0.05).Three months after the operation,80 patients were followed up one by one and found that the Cobb angle(°),the height of the anterior edge of the vertebral body(%),and the loss of correction of long segment internal fixation and short segment internal fixation were compared,the difference was statistically significant.Conclusion:Short-segment fixation and long-segment internal fixation through the posterior approach have a very significant effect in the treatment of thoracolumbar spine fractures,,and can get good reduction and deformity correction during operation.However,in the short segment group,the pedicle internal fixation system is prone to the situation of loss of correction,loosening or displacement of screws,loss of anterior height of vertebral body(%),loss of Cobb angle(°)again,and further increase and so on.