后路内固定融合术治疗不同分型胸腰椎骨折的临床疗效

Clinical efficacy of posterior fixation and fusion for different types of thoracolumbar fractures

中文关键词:  后路内固定融合术  胸腰椎骨折  Denis分型

英文关键词:Posterior fixation and fusion  Thoracolumbar fracture  Denis type

中文摘要:

  【摘要】 目的：探讨后路内固定融合术治疗不同分型胸腰椎骨折的疗效。方法：2010年1月～2015年1月收治的120例胸腰椎骨折患者依据随机数字表法分为两组，观察组60例，采用后路内固定融合术治疗，对照组60例，采用单纯后路内固定术治疗。应用手术时间、术中出血量和术后切口引流量评价手术情况，应用视觉模拟评分（VAS）评价患者腰痛情况，应用Roland-Morris功能障碍（RDQ）评分评价患者腰椎障碍情况，比较两组患者及不同分型（Denis分型A、B、C、D型）胸腰椎骨折患者的临床疗效。结果：观察组融合率为87.9%，治疗有效率为93.3%，手术时间、出血量和切口引流量分别为77.9±1.5min、387.4±9.4ml和115.8±6.4ml。术前、术后1d和术后3个月时的VAS评分分别为7.9±1.0分、7.6±1.0分和3.5±0.5分；RDQ评分分别为21.8±1.8分、18.4±1.1分和11.8±0.9分。对照组治疗总有效率为80.0%，手术时间、出血量和切口引流量分别为65.6±1.7min、309.4±7.1ml和103.2±6.3ml。术前、术后1d和术后3个月时的VAS评分分别为7.6±1.7分、7.2±1.1分和3.9±0.6分，RDQ评分分别为22.1±1.7分、19.4±1.0分和15.5±1.1分。两组患者间治疗有效率、手术时间、出血量和切口引流量、术后3个月的VAS评分、术后1d和术后3个月的RDQ评分差异具有统计学意义（P<0.05）。Denis分型A、B、C和D型患者术前VAS评分分别为8.1±0.9分、7.3±1.2分、7.8±0.9分和7.9±0.8分；术后1d时分别为4.1±1.0分、7.6±1.1分、7.7±1.0分和7.8±1.0分；术后3个月时分别为3.5±0.8分、3.6±0.6分、3.7±0.5分和3.8±0.5分，患者经治疗后VAS评分显著下降（P<0.05），但B、C和D型患者术后1d时VAS评分均显著高于A型患者（P<0.05）。A、B、C和D型患者术前RDQ评分分别为17.8±1.9分、23.1±2.0分、23.4±2.1分和22.8±1.9分；术后1d时分别为12.4±1.1分、17.3±1.4分、18.3±1.8分和18.9±1.5分；术后3个月时分别为11.9±1.9分、11.4±1.3分、11.5±1.9分和12.4±1.9分，患者经治疗后RDQ评分显著下降（P<0.05），但B、C和D型患者术前和术后1d时RDQ评分均显著高于A型患者（P<0.05）。结论：后路内固定融合术疗效确切，能够快速缓解Denis A型患者疼痛和脊柱功能障碍，并恢复损伤严重的Denis B、C和D型患者脊柱功能，重建脊柱稳定性，适用范围广，值得临床应用。

英文摘要:

  【Abstract】 Objectives: To explore the different types of treatment of posterior fixation and fusion for thoracolumbar fracture classifications. Methods: 120 cases with thoracolumbar fractures receiving surgery from January 2010 to January 2015 were randomly divided into 2 groups, obsrervation group contained 60 cases treated with posterior fixation and fusion surgery, control group contained 60 cases treated with posterior fixed non-fusion treatment. The operation time, blood loss and postoperative evaluation of surgical incision drainage, the visual analogue scale(VAS), Roland-Morris dysfunction(RDQ) evaluation were used for evaluation, the clinical efficacy of different types of thoracolumbar fractures between two groups were compared. Results: Fusion rate in observation group was 87.9%, with the treatment efficiency of 93.3%; operation time, blood loss and incision drainage was 77.9±1.5min, 387.4±9.4ml, 115.8±6.4ml respectively. At preoperation, 1 day and 3 months after surgery, the VAS score was 7.9±1.0, 7.6±1.0 and 3.5±0.5 respectively; RDQ score was 21.8±1.8, 18.4±1.1 and 11.8±0.9 respectively. At control group, the total effective rate was 80.0%, the operation time, blood loss and incision drainage were 65.6±1.7min, 309.4±7.1ml, 103.2±6.3ml respectively. At preoperation, 1 day and 3 months after surgery, VAS score was 7.6±1.7, 7.2±1.1, 3.9±0.6 respectively; RDQ score was 22.1±1.7, 19.4±1.0 and 15.5±1.1 respectively. The treatment efficiency, operation time, blood loss and incision drainage, VAS score after 3 months, postoperative 1 day and 3 months RDQ score were statistically significant(P<0.05). Denis A, B, C and D type preoperative VAS scores were 8.1±0.9, 7.3±1.2, 7.8±0.9 and 7.9±0.8; postoperative 1 day VAS scores were 4.1±1.0, 7.6±1.1, 7.7±1.0 and 7.8±1.0; postoperative 3 months VAS scores were 3.5±0.8, 3.6±0.6, 3.7±0.5 and 3.8±0.5. The patients′ postoperative VAS scores decreased significantly(P<0.05), but postoperative 1 day VAS scores of B, C and D type patients were significantly higher than that in patients with A type(P<0.05). Denis A, B, C and D type preoperative RDQ scores were 17.8±1.9, 23.1±2.0, 23.4±2.1 and 22.8±1.9 respectively; postoperative 1 day RDQ scores were 12.4±1.1, 17.3±1.4, 18.3±1.8 and 18.9±1.5 respectively, postoperative 3 months RDQ scores were 11.9±1.9, 11.4±1.3, 11.5±1.9 and 12.4±1.9 respectively. RDQ scores of four types of patients decreased significantly(P<0.05), but postoperative 1 day RDQ scores of B, C and D type patients were significantly higher than that in patients with A type(P<0.05). Conclusions: The posterior fixation and fusion is superior than non-fusion, which can quickly relieve pain and improve spinal cord function for Denis A type fracture, and restore spinal stability for Denis B, C and D fracture.