两种方式治疗胸腰椎爆裂骨折的疗效比较

The effect comparison of two surgical methods for burst fractures of thoracolumbar vertebrae

目的比较切除椎板和保留椎板椎弓根钉内固定术治疗Denis B型胸腰椎爆裂骨折的疗效。方法将46例Denis B型胸腰椎爆裂骨折患者根据治疗方法的不同分为A组(18例,采用切除椎板椎弓根钉内固定术治疗)和B组(28例,采用保留椎板椎弓根钉内固定术治疗)。记录两组术中出血量、手术时间、伤椎后凸Cobb角及末次随访脊髓损伤Frankel分级。结果患者均获得随访,时间13~26个月。术中出血量及手术时间A组多(长)于B组(P<0.05)。伤椎后凸Cobb角:术后两组比较差异无统计学意义(P>0.05),术后1年A组大于B组(P<0.05)。末次随访脊髓损伤Frankel分级两组比较差异无统计学意义(P>0.05)。结论保留椎板和切除椎板椎弓根钉内固定术治疗Denis B型胸腰椎爆裂骨折均能取得良好的疗效,但保留椎板椎弓根钉内固定术具有手术时间短、术中出血量少、术后后凸Cobb角维持较好的优点。

Objective To compare the efficacy of pedicle screw internal fixation with laminectomy and lamina-preserving in the treatment of Denis type B thoracolumbar burst fractures.Methods A total of 46 patients with Denis type B thoracolumbar burst fractures were divided into group A(18 patients were treated by pedicle screw with laminectomy)and group B(28 patients were treated by pedicle screw with lamina-preserving),according to different treatment methods.The intraoperative blood loss,operation time,and kyphotic Cobb angle of the injured vertebrae,Frankel grade of spinal cord injury at the last follow-up were recorded in the two groups.Results All patients were followed up for 13~26 months.Intraoperative blood loss and operation time were more(longer)in group A than those in group B(P<0.05).Kyphotic Cobb angle of the injured vertebrae:there was no significant difference between the two groups after operation(P>0.05),and group A was larger than group B at 1 year after operation(P<0.05).At the last follow-up,there was no significant difference in Frankle grade of the spinal cord injury between the two groups(P>0.05).Conclusions Denis type B thoracolumbar burst fracture can be treated with both lamina-preserved and lamina-resected pedicle screw internal fixation,and both methods can obtain good effect,but lamina-preserved pedicle screw internal fixation has the advantages of short operation time,less intraoperative blood loss and better postoperative kyphotic Cobb angle maintenance.