不同椎弓根螺钉内固定方式治疗胸腰段骨折的疗效分析

Analysis of the clinical effects of different pedicle screw fixation methods for the treatment of thoracolumbar fractures

目的:探讨不同椎弓根螺钉内固定方式治疗胸腰段骨折的疗效。方法:对2013年1月至2016年12月收治的55例胸腰椎单一椎体骨折患者的临床资料进行回顾性分析,其中男32例,女23例;年龄20~55岁,平均35.6岁;T118例,T1218例,L1 19例,L2 10例。根据AO分型,A1型10例,A2型17例,A3型18例,B2型7例,B3型2例,C1型1例。按内固定方式的不同分为3组,其中传统跨伤椎4钉固定20例,为对照组;伤椎双侧6钉固定22例,为双侧组;伤椎单侧5钉固定13例,为单侧组。比较3组患者一般情况:手术时间、手术出血量、住院费用;临床症状:视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI);影像学指标:术后即刻伤椎高度、Cobb角矫正率及末次随访伤椎高度、Cobb角丢失率。结果:所有患者获得随访,时间为12~20个月,平均15.2个月,术后均无内固定松动、断裂等并发症的发生。3组患者在手术时间、手术出血量方面差异无统计学意义(P>0.05);在住院费用方面,对照组(20 932.4±298.3)元明显低于单侧组[(22 428.2±321.5)]元与双侧组[(23 630.5±310.5)]元(P<0.05),且单侧组低于双侧组(P<0.05)。在VAS评分、腰椎ODI评分方面,3组间术前、术后1周、末次随访时比较差异均无统计学意义(P>0.05)。术后即刻伤椎高度、Cobb角矫正率3组间差异无统计学意义(P>0.05);末次随访时伤椎高度丢失率方面,单侧组[(6.3±2.1)%]和双侧组[(5.6±2.8)%]均优于对照组[(9.2±1.8)%](P<0.05),但单侧组和双侧组比较差异无统计学意义(P>0.05)。在末次随访时Cobb角丢失率方面,单侧组[(15.2±6.5)%]和双侧组[(13.9±7.2)%]均优于对照组[(23.6±7.5)%](P<0.05),但单侧组和双侧组比较差异无统计学意义(P>0.05)。结论:3种椎弓根螺钉内固定方式均适用于胸腰段骨折治疗,短期疗效相当;伤椎单侧固定与双侧固定在维持伤椎高度及防止后凸畸形发生上均优于传统跨伤椎固定;伤椎单侧固定与双侧固定临床效果相当,但单侧固定住院费用更低,值得临床推广。

Objective:To discuss the clinical effects of the different pedicle screw fixation methods for the treatment of thoracolumbar fractures.Methods:The clinical data of 55 patients with single thoracolumbar fractures treated between January 2013 and December 2016 were retrospectively analyzed.There were 32 males and 23 females,aged from 20 to 55 years with an average of 35.6 years old.All the fractures were located on a single segment,8 cases of T11,18 cases of T12,19 cases of L1,10 cases of L2.According to the classification of AO,10 cases were type A1,17 cases were type A2,18 cases were type A3,7 cases were type B2,2 cases were type B3,1 case was type C1.The patients were divided into three groups according to the different fixation methods,among them,20 cases treated by traditional short segment 4 pedicle screws fixation were control group,22 cases treated by intermediate bilateral pedicle screws fixation(6 pedicle screws fixation)were bilateral group,13 cases treated by intermediate unilateral pedicle screw fixation(5 pedicle screws fixation)were unilateral group.The three groups were compared by operation time,intraoperative blood loss,hospitalization cost,VAS and ODI scores,the correction of the fractured vertebrae height and kyphosis angle postoperatively and the losing rate of the fractured vertebrae height and kyphosis angle at the final follow up and so on.Results:All the patients were followed up from 12 to 20 months with an average of 15.2 months.No complications such as loosening of internal fixation and breakage were found after operation.There was no significant difference in operation time and intraoperative blood loss among three groups(P>0.05).In terms of hospitalization cost,the control group[(20 932.4±298.3)yuan]was significantly lower than the unilateral group[(22 428.2±321.5)yuan]and the bilateral group[(23 630.5±310.5)yuan](P<0.05),and the unilateral group was lower than the bilateral group(P<0.05).There was no significant difference in VAS and ODI scores at preoperative,postoperative 1 week and final follow up among the groups(P>0.05).And there was no significant difference in the correction of the injuried vertebrae height and kyphosis angle immediately after operation among three groups(P>0.05).However,for the losing rate of the injuried vertebrae height at the final follow up,the unilateral group[(6.3±2.1)%]and bilateral group[(5.6±2.8)%]were significantly better than the control group[(9.2±1.8)%](P<0.05),there was no significant difference between unilateral group and bilateral group;for the losing rate of kyphosis angle at the final follow up,the unilateral group[(15.2±6.5)%]and bilateral group[(13.9±7.2)%]were significantly better than the control group[(23.6±7.5)%](P<0.05),but there was no statistical difference between the unilateral and bilateral group(P>0.05).Conclusion:All the three different pedicle screw fixation methods are suitable for the treatment of thoracolumbar fractures and the short term clinical effects are consistent.Compared with traditional short segment 4 pedicle screws fixation,intermediate bilateral or unilateral pedicle screw fixation were more effective in maintaining the height of the injuried vertebrae and preventing the occurrence of kyphosis.The intermediate unilateral pedicle screw fixation was comparable to that of bilateral fixation at clinical outcomes,but the unilateral fixed hospitalization cost was lower,which was worthy of clinical promotion.