不同内固定方式治疗胸腰椎骨折的临床效果

Clinical effect of different internal fixation methods in the treatment of thoracolumbar fractures

目的探讨不同内固定方式治疗胸腰椎骨折的临床效果。方法选择本院2014年1月至2018年12月收治的54例胸腰椎骨折患者为研究对象,按照改良评分法对胸腰椎骨折严重程度进行分级,其中≤3分为轻度,4~6分为中度。根据伤椎固定方式的不同将患者分为A组(n=28)和B组(n=26),分别行短节段跨伤椎(4钉)内固定、短节段经伤椎(6钉)内固定。两组均行相同的术后处理,并随访1年。比较两组患者的手术时间、术中出血量、伤椎前缘高度比值及后凸Cobb角。结果A组患者手术时间显著短于B组,术中出血量显著少于B组,差异具有统计学意义(P<0.05)。两组患者术后即刻、术后半年、术后1年的伤椎前缘高度比值及后凸Cobb角均优于术前(P<0.05)。术后1年,两组轻度患者的伤椎前缘高度比值、后凸Cobb角比较,差异无统计学意义(P>0.05);A组中度患者的伤椎前缘高度比值低于B组,后凸Cobb角高于B组,差异具有统计学意义(P<0.05)。结论跨伤椎内固定和经伤椎内固定治疗胸腰椎骨折均能较好地改善伤椎高度和Cobb角;对于轻度骨折患者,行跨伤椎内固定更有利于缩短手术时间,减少术中出血量;对于中度骨折患者,行经伤椎内固定更利于改善伤椎前缘高度比值和后凸Cobb角。

Objective To investigate the clinical effect of different internal fixation methods in the treatment of thoracolumbar fractures.Methods Fifty-four patients with thoracolumbar fractures treated in our hospital from January 2014 to December 2018 were selected as the research objects.According to the improved scoring method,the severity of thoracolumbar fractures was graded,of which≤3 points was mild,and 4-6 points was moderate.According to the different fixation methods of injured vertebra,the patients were divided into group A(n=28)and group B(n=26)for short-segment cross-injured vertebra(4 screws)internal fixation and short-segment trans-injured vertebra(6 screws)internal fixation respectively.Both groups received the same postoperative treatment and were followed up for 1 year.The operation time,intraoperative blood loss,anterior height ratio of injured vertebrae and kyphosis Cobb angle were compared between the two groups.Results The operation time of the group A was significantly shorter than that of the group B,the intraoperative blood loss was significantly less than that of the group B,and the differences were statistically significant(P<0.05).The anterior height ratio of injured vertebrae and kyphosis Cobb angle in the two groups immediately,in half a year and one year after operation were better than those before operation(P<0.05).One year after operation,there were no significant differences in anterior height ratio of injured vertebrae and kyphosis Cobb angle of mild patients between the two groups(P>0.05);for moderate patients,the anterior height ratio of injured vertebra in the group A was lower than that in the group B,the Cobb angle was higher than that in the group B,and the differences were statistically significant(P<0.05).Conclusion The cross-injured vertebra internal fixation and trans-injured vertebra internal fixation for patients with thoracolumbar fractures can better improve the height of injured vertebrae and Cobb angle.For patients with mild fracture,cross-injured vertebra internal fixation is more conducive to shorten the operation time and reduce the intraoperative blood loss.For patients with moderate fracture,trans-injured vertebra internal fixation is more conducive to improve the anterior height ratio of injured vertebrae and kyphosis Cobb angle.