伤椎单侧与双侧置钉治疗胸腰段椎体骨折的比较研究

Comparative study on the treament of thoracolumbar vertebral fractures by unilateral and bilateral injured vertebral transpedicular fixtion

目的对比研究胸腰段椎体骨折伤椎单侧与双侧置钉的临床疗效。方法回顾分析2012年6月至2015年5月对胸腰椎骨折患者采用伤椎单侧(5钉组)和双侧置钉(6钉组)技术治疗86例(5钉组45例,6钉组41例)。分析对比组内及组间术前、术后、末次随访时的矢状位Cobb角、伤椎前缘高度和椎管内骨折复位情况;评估术前和术后VAS评分和ODI指数。结果两组患者性别、年龄、损伤节段和损伤类型、TLICS评分、椎体前缘高度和矢状位Cobb角差异无统计学意义。两组患者手术时间和出血量差异无统计学意义。末次随访时5钉组椎体前缘高度(23.1±4.3)mm、Cobb角11.7°±5.4°、VAS(1.4±0.9)、平均ODI(16.5%);6钉组椎体前缘高度(23.0±4.0)mm、Cobb角11.4°±3.4°、VAS(1.5±0.7)、平均ODI(17.2%);两组间差异无统计学意义(P>0.05)。6钉组出现2例骨折块复位不全,但两组差异无统计学意义(P>0.05)。结论对A型和部分B型胸腰段椎体骨折而言,伤椎单侧置钉技术同双侧置钉技术一样,可以有效地维持复位后伤椎的高度,维持胸腰段脊柱序列。

Objective To study the clinical effects of thoracolumbar vertebral fractures treated with unilateral and bilateral injured vertebral transpedicular fixtion. Methods From June 2012 to May 2015 86 cases of thoracolumbar fractures were treated with unilateral(5-screw group, 45 cases) and bilateral(6-screw group, 41 cases) injured vertebral transpedicular fixtion. Cobb angle, anterior vertebral height and fracture reduction were analyzed and compared within and between two groups. Preoperative and postoperative VAS score and ODI index were assessed. Results There was no significant difference in gender, age, injury segment and type, TLICS score, anterior vertebral height and sagittal Cobb angle between two groups. There was no significant difference in operation time and blood loss between two groups. At final follow-up, the anterior vertebral height(23.1±4.3) mm, the Cobb angle 11.7°±5.4°. VAS(1.4±0.9), and average ODI(16.5%) were recorded in 5-screw group. In 6-screw group, the anterior edge height of vertebral body was(23.0±4.0) mm, Cobb angle 11.4°±3.4°, VAS(1.5±0.7), average ODI(17.2%). There was no significant difference between two groups(P>0.05). The malreduction was founded in 2 cases of 6-screw group, but there was no significant difference between two groups(P>0.05). Conclusion For type A and part of type B of thoracolumbar vertebral fractures, the technique of unilateral injured vertebral transpedicular fixtion is the same to the bilateral technique. They can effectively maintain vertebral height and thoracolumbar spine sequence.