胸腰椎骨折三种不同内固定方式的疗效比较

Postoperative efficacy comparison among three fixation methods in the treatment of thoracolumbar fracture

中文关键词:  胸腰椎骨折  短节段内固定  经伤椎固定

英文关键词:Thoracolumbar fractures  Short-segmental fixation  Intermediate screws

中文摘要:

  【摘要】 目的：对比后路复位内固定治疗胸腰椎骨折中，传统短节段内固定、短节段内固定结合伤椎椎体成形术及经伤椎置钉三种不同内固定方式的临床疗效。方法：回顾性分析我院2010年1月~2014年10月收治的87例胸腰椎单节段骨折患者，其中30例行传统短节段内固定（A组），25例行短节段内固定结合伤椎椎体成形术（B组），32例行经伤椎置钉内固定（C组）。记录患者手术时间、术中出血量，测量手术前后及末次随访时的伤椎前缘高度比值（AVH）、区域后凸角（LKA）等影像学指标，在末次随访时观测CT矢状位及横断位上伤椎骨缺损程度及位置，并进行统计分析。采用汉化Oswestry功能障碍指数（ODI）评估腰背痛症状等。结果：所有病例均获得随访，平均15.5±2.3个月（13~21个月）。三组患者术中出血量无统计学差异（P>0.05），但B组的手术时间比A、C两组长，差异具有统计学意义（P<0.05）；比较三组术前、术后AVH、LKA无统计学差异（P>0.05），而末次随访时在AVH、LKA及汉化ODI评分等方面，A组均比B组、C组差（P<0.05），B、C两组比较则无统计学差异（P>0.05）。末次随访三组患者CT显示伤椎骨缺损在矢状面上主要位于椎体上1/3中部，在横断面上主要位于前柱的中央前缘部。A、B、C三组末次随访伤椎骨缺损程度分别为（18.6±7.3）％、（11.8±4.3）％、（8.4±2.1）％，组间两两比较差异具有显著性（P<0.01）。B、C两组无一例出现断钉断棒等现象，而A组则有3例断钉。结论：在后路复位内固定治疗胸腰椎骨折中，与传统短节段内固定相比，结合椎体成形术或经伤椎置钉均能有效维持矫正效果、重建椎体高度及减少内固定并发症，两者临床疗效相当；但经伤椎置钉固定因操作简单、安全，并能进一步有效降低伤椎骨缺损程度，更适合临床推广应用。

英文摘要:

  【Abstract】 Objectives: To compare the efficacy among single traditional transpedicular screw fixation, combined with vertebroplasty and combined with fractured vertebral transpedicular screws in treatment of thoracolumbar fracture. Methods: From January 2010 to October 2014, 87 consecutive patients with thoracolumbar single segment fractures were reviewed in this study, cases included 30 patients in group A(single transpedicular screw fixation), 25 patients in group B(combined with vertebroplasty) and 32 patients in group C(combined with fractured vertebral transpedicular screw fixation). The operative duration, blood loss were recorded. Changes in the anterior vertebral height ratio(AVH), local kyphosis angle(LKA) were measured preoperatively, postoperatively and at final follow-up. The vertebral defect degrees and sites in latest CT imaging and modified Oswestry disability index (ODI) in Chinese for each patient were recorded. Results: All the patients were followed up for an average of 15.5±2.3 months(13-21 months). The operative duration in group B was significantly longer than that in group A and group C(P<0.05). There was no difference in blood loss among the 3 groups, neither the anterior vertebral height ratio nor the local kyphosis angle was noted preoperatively and postoperatively(P>0.05). The AVH, LKA and ODI in group B and group C were higher than that in group A at final follow up(P<0.05), but there was no significant difference between group C and group B(P>0.05). The CT scans showed the bone defects mainly existed in one-third of the vertebral body in sagittal section and the central anterior edge. The degrees of bone defects in group A, B and group C were (18.6±7.3)％, (11.8±4.3)％, (8.4±2.1)％ respectively(P<0.01). 3 cases were noted fixation failure in group A, while there was no failure in group B or C. Conclusions: Our study indicates that fixation combined with vertebroplasty or fractured vertebral transpedicle screws provides better effect in vertebral height restoration and less complication incidence than single traditional transpedicular screw fixation. But the former seems to be safer and easier and can decrease the degree of bone defect effectively. It is a better choice for thoracolumbar spine fracture.