后路切开复位椎间加压单节段内固定治疗胸腰椎骨折脱位的疗效观察

目的 探讨后路切开复位椎间加压单节段内固定治疗胸腰椎骨折脱位的效果.方法 纳入后路切开复位椎间加压经伤椎内固定治疗的胸腰椎骨折脱位患者62例,根据内固定节段分为两组,经伤椎椎体置钉的单节段4钉固定(伤椎及上方脱位椎固定)为单节段固定组(35例).经伤椎椎体置钉的双节段6钉固定(伤椎及伤椎的上下两个椎体固定)作为短节段固定组(27例),统计两组手术情况、术后并发症发生率及末次随访时ASIA功能评分,比较两组术前及术后1个月、末次随访骨折节段Cobb角、伤椎椎体前缘高度比伤椎前后移位比、伤椎侧方移位比.结果 单节段固定组手术时间、切口长度短于短节段固定组,术中出血量少于短节段内固定组,差异有统计学意义(P<0.001);两组末次随访时ASIA功能评分均较术前前改善(P<0.05),但两组末次随访时组间比较,差异无统计学意义(P>0.05).结论 后路切开复位椎间加压经伤椎单节段内固定和短节段内固定治疗胸腰椎骨折脱位在神经功能恢复、骨折节段Cobb角、伤椎椎体前缘高度比及椎前后、侧方移位比上效果基本一致,但单节段内固定可进一步缩短手术时间,减少术中出血量.

Objective To investigate the effects of posterior open reduction and interbody compression with single segment fixation in the treatment of thoracolumbar fracture and dislocation. Methods A total of 62 patients with thoracolumbar fracture and dislocation treated by posterior open reduction,interbody compression and internal fixation were enrolled in the study. According to the segment of internal fixation,the patients were divided into single segment fixation group [treated by single-segment fixation with 4 vertebral screws(fixation for injured vertebral body and upper dislocated vertebral body),35 cases]and short segment fixation group (treated by double-segment fixation with 6 vertebral screws(fixation for injured vertebral body and 2 below and above vertebral bodies),27 cases)The condition of surgery,the incidence of complications after surgery and ASIA function scores at the time of the latest follow-up in the two groups were statistically analyzed. The Cobb angles of fractured segments,ratios of anterior heights,anterior-posterior shift and lateral dislocation of injured vertebral bodies were compared between the two groups before surgery,at 1 month after surgery and at the time of the latest follow-up. Results The surgical time and length of incision of the single segment fixation group were shorter than those of the short segment fixation group,and the blood loss was less than that of the short segment fixation group(P<0.001). ASIA functional scores were improved in the two groups at the time of the latest follow-up(P<0.05),but there was no significant difference between the two groups(P>0.05). Conclusion The effects of posterior open reduction and interbody compression with single segment fixation and short segment fixation are similar in the treatment of thoracolumbar fracture and dislocation,in terms of neurological function recovery,Cobb angle,ratios of anterior height,anterior-posterior shift and lateral dislocation. However, single segmental fixation can further shorten the surgical time and reduce blood loss during surgery.