经后路短节段结合伤椎椎弓根内固定治疗胸腰椎爆裂型骨折的疗效分析

Curative Effect of Posterior Short-Segment Combined with Vertebral Pedicle Internal Fixation for Thoracolumbar Burst Fracture

目的:分析经后路短节段结合伤椎椎弓根内固定治疗胸腰椎爆裂型骨折的疗效。方法:收集2016年6月至2018年1月我院收治的胸腰椎爆裂型骨折176例,其中92例行经后路短节段结合伤椎椎弓根内固定(观察组),84例行经后路长节段椎弓根内固定(对照组);比较两组围手术期指标及末次随访时腰背疼痛视觉模拟(VAS)评分、Oswestry功能障碍指数(ODI)、Frankel功能分级和Cobb's角、椎体前缘高度改善情况,并观察不良事件发生情况。结果:观察组手术时间、术中出血量及术后住院时间均明显少于对照组(P<0.05)。末次随访时,两组VAS评分、ODI评分及Frankel功能分级改善情况对比无统计学差异(P>0.05),而观察组Cobb's角、椎体前缘高度恢复情况均明显优于对照组(P<0.05)。两组术后均无不良事件,无内固定失败病例。结论:经后路短节段结合伤椎椎弓根内固定治疗胸腰椎爆裂型骨折能够有效恢复伤椎高度,矫正后凸畸形,疗效优于长节段椎弓根内固定。

Objective:To analyze the curative effect of posterior short-segment combined with vertebral pedicle internal fixation for thoracolumbar burst fracture.Methods:176 patients with thoracolumbar burst fractures admitted to the hospital from June 2016 to January 2018 were enrolled.Among them,92 patients underwent posterior short-segment combined with vertebral pedicle internal fixation(observation group).84 patients underwent long-segment pedicle fixation through posterior approach(control group).The perioperative indicators,score of visual analogue scale(VAS)of pain in back and loin,Oswestry dysfunction index(ODI),Frankel functional grading at the last follow-up,Cobb's angle and improvement of vertebral anterior edge height were compared between the two groups.The occurrence of adverse events was observed.Results:The operation time,intraoperative blood loss and postoperative hospital stay in observation group were significantly less than those in control group(P<0.05).At the last follow-up,there was no significant difference in the improvement of VAS score,ODI score or Frankel functional grading between the two groups(P>0.05),while the recovery of Cobb's angle and vertebral anterior edge height in observation group was significantly better than that in control group(P<0.05).There were no adverse events after operation in both groups.And there was no case with the failure of internal fixation.Conclusion:Posterior short-segment combined with vertebral pedicle internal fixation can effectively restore the height of the injured vertebrae in the treatment of thoracolumbar burst fracture and correct the kyphosis.The curative effect is better than that of long-segment pedicle fixation.