经伤椎置钉6钉与4钉内固定治疗A1型胸腰椎骨折临床疗效比较

Comparison of the clinical effects of 6 pedical screw and 4 pedical screw internal fixation on the treatment of type A1 theoracolumbar fracture

目的比较经伤椎置钉6钉2棒与4钉2棒内固定治疗A1型胸腰椎骨折的临床疗效。方法 2015年1月至2018年1月,六安市第二人民医院分别采用经伤椎置钉6钉2棒与经伤椎置钉4钉2棒治疗A1型胸腰椎骨折21例和20例。观察两组病人手术时间、术中+术后出血量、椎体的前缘高度百分比、Cobb角等情况,比较两者临床疗效。结果两组病人随访时间范围10~32个月,平均随访时间16月。6钉2棒组术前椎体前缘高度百分比为(44.3±15.4)%,术后7 d、术后3个月、术后6个月的椎体前缘高度百分比分别为(97.2±5.8)%、(96.3±6.5)%、(95.6±6.8)%。4钉2棒组术前椎体前缘高度百分比为(43.8±15.0)%,术后7 d、术后3个月、术后6个月的椎体前缘高度百分比分别为(90.5±8.8)%、(90.1±8.1)%、(88.2±8.3)%。两组间比较差异无统计学意义(P>0.05)。6钉2棒组病人术前Cobb角(22.0±7.0)°,术后7 d、术后3月、术后6月的Cobb角分别为(5.9±3.6)°、(6.3±3.6)°、(6.6±3.5)°。4钉2棒组病人术前、术后7d、术后3月及术后6月的Cobb角分别为(21.1±6.4)°、(6.1±2.5)°、(6.8±3.1)°、(7.1±4.8)°,两组间相比较,差异无统计学意义(P>0.05)。6钉2棒组手术时间(67.0±7.0)min,与4钉2棒组手术时间(52.0±6.0)min比较,差异有统计学意义(P<0.01)。两组病人术中+术后出血量(470.3±60.7)、(282.1±31.3)mL比较差异有统计学意义(P<0.01)。结论对于A1型胸腰段骨折,经伤椎置钉6钉内固定和4钉内固定都能有效恢复椎体前缘高度,改善Cobb角。但是,使用4枚椎弓根内固定具有手术时间短、术中和术后出血量少的优点。

Objective To compare the clinical effect of 6 pedicle screw and 4 pedicle screw internal fixation on type A1 thoracolnmbar fracture.MethodsFrom January 2015 to January 2018,21 cases and 20 cases of A1 thoracolumbar fracture were treated with 6 pedicle screw and 4 pedicle screw internal fixation,respectively.The operation time and blood loss during and after operation,antserior height of vertebral body before and after operation,Cobb angle before and after operation were obeerved,and theclinical effects of the two groups were compared.Results All patients were followed up for 10-32 months,withanaveragetimeof 16 months.In the 6 pedicle screw group,the anterior height of vertebral was(44.3±15.4)%before operation,(97.2±5.8)%,(96.3±6.5)%and(95.6±6.8)%at 7 days,3 months and 6 months after operation,respectively.In the 4 pedicle screw group,the anterior height of vertebral was(43.8±15.0)%befor opertion,(90.5±8.8)%,(90.1±8.1)%and(88.2±8.3)%at 7 days,3 months and6 months after operation,respectively.No significant difference was found in anterior vertebral body height between the two groups(P>0.05).In the6 pedicle screw group,preoperative Cobb angle was(22.0±7.0)°,and Cobb angle at postoperative 7 days,3 months and6 months was(5.9±3.6)°,(6.3±3.6)°,(6.6±3.5)°,respectively.In the 4 pedicle screw group,preoperative Cobb angle was(21.1±6.4)°,and Cobb angle at postoperative 7 days,3 months and 6 months was(6.1±2.5)°,(6.8±3.1)°,(7.1±4.8)°,respectively.No significant difference in Cobb angle was found between the two groups.The operation time of 6 pedicle screw group was(67.0±7.0)minutes,and that of 4 pedicle screw group was 52.0±6.0 minutes.There was a significant difference between the two groups(P<0.01).The amount of bleeding during and after operation was(470.3±60.7)mL in 6 pedicle group and(282.1±31.3)mL in 4 pedicle screw group.There was a significant difference between the two groups(P<0.01).Conclusions For type A1 thoracolumbarfractures,both 6 pedicle screw internal fixation and 4 pedicle screw internal fixation can effectively restore the anterior height ofthe vertebral body and improve the cobb angle.However,the use of four pedicle screw internal fixation has the advantages of shorte roperation time and less bleeding during and after operation.