经伤椎固定与跨伤椎固定治疗胸腰段脊柱骨折的疗效比较

Comparison of the efficacy of transpedicular fixation and trans-traumatic-verterbral fixation in the treatment of thoracolumbar spinal fractures

目的:对比分析经伤椎固定与跨伤椎椎弓根螺钉内固定治疗胸腰段脊柱骨折的疗效。方法:82例胸腰段脊柱骨折(其中63例合并脊髓损伤)患者按照手术固定方式不同分为A组(跨伤椎固定,n=41)和B组(经伤椎固定,n=41)。术前、术后即刻采用视觉模拟疼痛(VAS)评分、日本骨科协会评估治疗(JOA)评分评定手术疗效,比较两组患者术前术后Cobb角、伤椎椎体前、后缘椎体高度等指标。结果:A、B两组术前VAS、JOA评分,Cobb角、术后即刻矫正度、术后半年矫正丢失度,伤椎椎体前、后缘椎体高度比较无统计学意义(P均>0.05),术后即刻两组VAS评分均明显降低,JOA评分均明显升高,术后即刻、术后半年Cobb角均较术前显著减小,与术前比较差异均有统计学意义(P均<0.05)。术后两组VAS、JOA评分无统计学意义(P>0.05)。B组术后Cobb角、即刻矫正度、半年矫正丢失度均优于A组,差异有统计学意义(P<0.05)。与A组比较,B组术后1年伤椎椎体前、后缘椎体高度维持效果更好,差异有统计学意义(P<0.05)。结论:经伤椎椎弓根螺钉内固定治疗胸腰段脊柱骨折临床复位效果更突出,术后脊柱矫正度维持效果更好,故更具推广价值。

Objective:To compare the efficacy of transpedicular fixation and trans-traumatic-verterbral fixation in the treatment of thoracolumbar spinal fractures.Methods:Eighty-two patients with thoracolumbar spinal fractures(63 patients with spinal cord injury) were divided into A group(transpedicular fixation,n=41)and group B(trans-traumatic-verterbral fixation,n=41) according to different fixation methods.The efficacy of surgery was evaluated with visual analogue score(VAS) and Japan Orthopedic Association(JOA) score.The Cobb angle,transpedicular anterior and posterior height were compared between the two groups.Results:The VAS and JOA scores before surgery,Cobb angle,immediate postoperative correction degree,correction loss six months after surgery,transpedicular anterior and posterior height showed no significant differences between the two groups(P>0.05).Immediately after the surgery,the VAS scores of the two groups decreased significantly while JOA scores increased significantly.Immediately after surgery and half a year after surgery,Cobb angles decreased significantly(P<0.05).After surgery,there were no significant differences in VAS and JOA scores between the two groups(P>0.05).After surgery,the Cobb angle,immediate correction degree,correction loss in six months in B group were better than those in A group(P<0.05).The maintenance of 1-year transpedicular body anterior and posterior heights n B group was better than A group(P<0.05).Conclusion:The clinical reduction effect of transpedicular screw fixation is better in the treatment of thoracolumbar spinal fractures,and the maintenance of spinal correction after surgery is better.