单纯椎弓根螺钉短节段固定治疗胸腰椎骨折

The short-segment fixation with simple pedicle screw foRtreatment of thoracolumbaRfracture

目的探讨单纯椎弓根螺钉短节段固定治疗胸腰椎骨折的临床疗效。方法将156例胸腰椎骨折患者按照随机数字表法分为观察组(采用单纯椎弓根螺钉短节段固定,78例)和对照组(采用椎弓根螺钉短节段固定+后外侧植骨融合固定,78例)。比较两组手术时间、术中出血量、伤椎高度百分比、矢状位Cobb角、椎管面积。采用改良Prolo功能评分评价临床疗效。结果患者均获得随访,时间12~18个月。手术时间、术中出血量:观察组均明显短(少)于对照组(P<0.05)。伤椎高度百分比:两组术后3 d、12个月均明显高于术前(P<0.01);矢状位Cobb角:两组术后3 d、12个月均明显小于术前(P<0.01),术后12个月观察组明显小于对照组(P<0.01)。术后12个月两组均行拆除内固定术,均未出现内固定松动及断裂情况。末次随访时,采用改良Prolo功能评分评价的临床疗效优良率两组比较差异无统计学意义(P>0.05)。结论与椎弓根螺钉短节段固定+后外侧植骨融合固定相比,采用单纯椎弓根螺钉短节段固定治疗胸腰椎骨折能获得同样满意的疗效。

Objective To investigate the clinical effect of short-segment fixation with simple pedicle screw in the treatment of thoracolumbaRfracture.Methods A total of 156 patients with thoracolumbaRfractures were randomly divided into observation group(78 cases were performed with short-segment fixation with simple pedicle screw)and control group(78 cases were adopted with short-segment fixation with simple pedicle screw plus posterolateral bone grafting fusion fxiation),according to random numbeRtable.The operative time,intraoperative blood loss,percentage of injured vertebral height,sagittal Cobb angle and the spinal canal area were compared between the two groups.Clinical efficacy was evaluated by using modified Prolo functional score.Results All patients were followed up foR12~18 months.The duration of operation and the volume of intraoperative blood loss in the observation group were significantly shorter(less)than those in the control group(P<0.05).At 3 d,12 months afteRoperation,the percentage of injured vertebral height in the two groups were significantly higheRthan those before operation(P<0.01);the sagittal Cobb angles were significantly loweRthan those before operation(P<0.01),and which of the observation group were significantly smalleRthan those in the control group at 12 months afteRoperation(P<0.01).At 12 months afteRthe operation,both groups removed internal fixation,and there was no loosening oRfracture of internal fixation.At the last follow-up,there was no statistical significance in the excellent-good rate of clinical efficacy evaluated by modified Prolo functional score between the two groups(P>0.05).Conclusions Compared with short-segment fixation with pedicle screw plus posterolateral bone grafting fusion fixation,short-segment fixation with simple pedicle screw alone can achieve the same satisfactory effect in the treatment of thoracolumbaRfracture.