经伤椎单向与万向椎弓根螺钉内固定治疗胸腰椎骨折疗效比较

Comparison of therapeutic effect between monaxial and multiaxial pedical screw fixation for thoracolumbar fracture

背景:经伤椎短节段椎弓根螺钉内固定术治疗胸腰椎骨折应用广泛,然而伤椎置钉尚存在单向和万向椎弓根螺钉的争议。目的:比较经伤椎单侧单向与万向椎弓根螺钉联合短节段内固定治疗单节段胸腰椎骨折的临床和影像学疗效。方法:回顾性分析2015年1月至2017年6月收治的单节段胸腰椎骨折(T11-L2)患者46例。20例患者伤椎使用单向椎弓根螺钉内固定(单向钉组),26例患者伤椎使用万向椎弓根螺钉内固定(万向钉组)。记录并比较两组患者手术时间、术中失血量、手术前后腰部疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、局部后凸角、椎体楔形角、椎体前缘高度比。结果:所有患者均获得随访,随访时间12~18个月,平均(14.5±2.5)个月。单向钉组患者平均手术时间长于万向钉组患者[(114±21)min vs(101±22)min],且差异有统计学意义(t=2.09,P=0.04);而两组患者术中失血量差异无统计学意义。术前、术后3 d、末次随访时两组患者腰部疼痛VAS评分差异均无统计学意义;术前、末次随访时两组患者ODI差异也均无统计学意义。两组患者术前、术后3 d、末次随访时局部后凸角、椎体楔形角、椎体前缘高度比差异也均无统计学意义。末次随访时,两组患者局部后凸角丢失度、椎体楔形角丢失度、椎体前缘高度比丢失值差异均无统计学意义。两组患者均无内固定失败发生。结论:采用万向椎弓根螺钉与单向椎弓根螺钉联合短节段内固定治疗胸腰椎骨折能够获得相似的临床和影像学疗效。万向椎弓根螺钉操作相对简单,能够缩短手术时间。

Background:Short-segment fixation with pedicle screw via injured vertebrae is widely used for the treatment of thoracolumbar fractures;however,there are still controversies about monaxial and multiaxial pedicle screws.Objective:To compare clinical and radiographic outcomes of short-segment fixation with monaxial and multiaxial pedicle screw in singlesegment thoracolumbar fractures.Methods:A retrospective case-control study was conducted on the clinical and radiographic data of 46 patients with single segment thoracolumbar fractures(T11-L2)from January 2015 to June 2017.Monaxial screw was used in 20 patients and multiaxial screw was applied in 26 patients.The operation time,intraoperative blood loss,visual analogue scale(VAS)score,Oswestry dysfunction index(ODI),local kyphosis angle,injured vertebral wedge angle and anterior vertebral height ratio were compared between monaxial screw group and multiaxial screw group.Results:All patients were followed up for(14.5±2.5)months on average(range,12-18 months).The mean operation time was significantly longer in monaxial screw group than that of in multiaxial screw group([114±21]min vs[101±22]min,t=2.09,P=0.04).There was no significant difference in intraoperative blood loss between the two groups(P>0.05).Neither were VAS score before surgery,after surgery and at the last follow-up,ODI before surgery and at the last follow-up(P>0.05).The local kyphosis angle,injured vertebral wedge angle and anterior vertebral height ratio were similar between the two groups before the operation,3 days after the operation and at the final follow-up(P>0.05).No significant difference was found either between the two groups in the loss of local kyphosis angle,injured vertebral wedge angle or anterior vertebral height ratio at the final follow-up(P>0.05).No fixation failed in this study.Conclusions:Both monaxial and multiaxial pedicle screw short-segment fixation can achieve similar clinical and radiographic results for the treatment of thoracolumbar fracture.The multiaxial pedicle screw fixation has the advantages of easier operation and shorter operation time.