后部韧带复合体损伤对胸腰椎爆裂性骨折后路椎弓根系统复位内固定手术效果的影响

Influence of posterior ligament complex injury on the effect of posterior pedicle system reduction and internal fixation for thoracolumbar burst fracture

目的分析后部韧带复合体(PLC)损伤对胸腰椎爆裂性骨折后路椎弓根系统复位内固定手术效果的影响。方法回顾性分析2016年1月至2018年12月在本院接受后路椎弓根系统复位内固定治疗的33例合并PLC损伤的胸腰椎爆裂性骨折患者和41例单纯爆裂性骨折患者的临床资料。比较两组的伤椎Cobb角、前缘高度、后缘高度、VAS、ODI、SF-36评分。结果两组内术前、出院时、术后6个月、末次随访时的伤椎Cobb角、前缘高度、后缘高度、VAS、ODI、SF-36评分均有显著差异(P<0.01);两组出院时、术后6个月、末次随访时的伤椎Cobb角、前缘高度、后缘高度、VAS、ODI、SF-36评分均优于术前(P<0.01);对照组末次随访时的伤椎Cobb角、前缘高度、后缘高度、VAS、ODI、SF-36评分均优于研究组(P<0.01)。结论PLC损伤对胸腰椎爆裂性骨折患者早期后路椎弓根系统复位内固定治疗效果无明显影响,但会导致其后期椎体高度丢失,出现后背畸形和腰背疼痛,影响远期生活质量。

Objective To analyze the influence of posterior ligament complex(PLC)injury on the effect of posterior pedicle system reduction and internal fixation for thoracolumbar burst fracture.Methods The clinical data of 33 cases of thoracolumbar burst fracture with PLC injury and 41 cases of simple thoracolumbar burst fracture treated by posterior pedicle system reduction and internal fixation in our hospital from January 2016 to December 2018 were analyzed retrospectively.The Cobb angle,anterior margin height,posterior margin height of the injured vertebrae,scores of VAS,ODI and SF-36 were compared between the two groups.Results There were significant differences in the Cobb angle,anterior margin height,posterior margin height of the injured vertebrae,scores of VAS,ODI and SF-36 of the two groups before surgery,at the time of discharge,at 6 months after surgery,and at the last follow-up(P<0.01);the Cobb angle,anterior margin height,posterior margin height of the injured vertebrae,scores of VAS,ODI and SF-36 of the two groups at the time of discharge,6 months after surgery and the last follow-up were better than those before surgery(P<0.01);the Cobb angle,anterior margin height,posterior margin height of the injured vertebrae,scores of VAS,ODI and SF-36 at the last follow-up of the control group were better than those of the study group(P<0.01).Conclusion PLC injury has no significant influence on the effect of early posterior pedicle system reduction and internal fixation in patients with thoracolumbar burst fracture,but it will lead to the loss of vertebral height in the later stage,back deformity and back pain,and affect the long-term quality of life.