后路短节段固定伤椎置钉与不置钉治疗轻中度胸腰椎爆裂性骨折的疗效比较

Comparison of posterior short segment fixation with versus without inclusion of the fracture level in the treatment of mild to moderate thoracolumbar burst fractures

中文关键词:  胸腰椎爆裂性骨折  伤椎置钉  载荷分享评分  短节段固定  后路

英文关键词:Thoracolumbar burst fracture  Intermediate screw  Load sharing classification  Short segment fixation  Posterior

中文摘要:

  【摘要】 目的：比较后路短节段固定伤椎不置钉与伤椎置钉两种手术方式治疗轻中度胸腰椎爆裂性骨折的疗效。方法：回顾性分析2012年6月~2016年6月在东莞市第三人民医院行后路短节段固定手术治疗的60例轻中度胸腰椎爆裂性骨折患者的临床资料，年龄25~55岁（39.4±8.4岁），男33例，女27例，骨折节段：T11 3例，T12 8例，L1 10例，L2 6例，L3 2例，AO分型均为A3型，载荷分享评分（load-sharing classification，LSC）为3~5分，胸腰椎损伤分型和严重评分（thoracolumbar injury classification and severity score，TLICS） ≥4分，随访时间超过1.5年（18.8±2.8个月）。其中伤椎不置钉组（SSPF组）29例（4钉固定），伤椎置钉组（PSFFV）31例（6钉固定）。分别对比两组患者年龄、性别、体重指数、骨折节段、LSC评分、TLICS评分、手术时间、术中出血量、术后引流量、并发症、住院时间与费用，术前、术后1周与末次随访时的伤椎椎体前缘高度、伤椎椎体楔形角、腰痛视觉模拟评分（visual analog scale，VAS），骨折愈合时间，重返工作岗位时间。结果：两组患者年龄、性别、体重指数、骨折节段、LSC评分、TLICS评分均无显著性差异（P>0.05）。SSPF组在手术时间、术后引流量、住院费用等方面均优于PSFFV组，两组间差异有统计学意义（P<0.05），两组的术中出血量及住院时间无显著性差异（P>0.05）。两组在术中均未出现血管损伤、脊髓神经根损伤，术后无伤口感染等严重并发症的发生。两组患者术后1周时的伤椎椎体楔形角、椎体前缘高度、VAS评分与术前比较均明显改善（P<0.05），末次随访时伤椎椎体楔形角、椎体前缘高度与术后1周对比无显著性差异（P>0.05），末次随访时的VAS评分与术后1周对比有显著性差异（P<0.05）。两组患者间术前、术后1周及末次随访时的伤椎椎体楔形角、椎体前缘高度及VAS评分均无显著性差异（P>0.05），两组患者的骨折愈合时间及重返工作时间均无显著性差异（P>0.05）。结论：后路短节段固定伤椎不置钉与伤椎置钉两种手术方式治疗轻中度胸腰椎爆裂性骨折均安全、有效，能恢复及维持脊柱稳定。

英文摘要:

  【Abstract】 Objectives: To compare the clinical efficacy of posterior short-segment pedicle screw fixation (SSPF) with posterior short-segment fixation including the fractured vertebra(PSFFV) in the treatment of mild to moderate thoracolumbar burst fractures(TBFs). Methods: The clinical data of 60 patients(33 males, 27 females) with mild and moderate thoracolumbar fractures treated with posterior short segment fixation in Dongguan Third People′s Hospital from June 2012 to June 2016 were analyzed retrospectively. The age range was 25-55 years old(39.4±8.4) with: T11 fracture in 3 cases, T12 fracture in 8 cases, L1 in 10 cases, L2 in 6 cases, and L3 in 2 cases. AO classification of all the patients was A3, load sharing score(LSC) was 3-5, thoracolumbar injury classification and severity score(TLICS) ≥4 points, and all patients were followed up for more than 1.5 years(18.8±2.8 months). 29 cases (4 screws) were included in short-segment pedicle screw fixation(SSPF group) and 31 cases(6 screws) in posterior short-segment fixation including the fractured vertebra (PSFFV group). The age, sex, body mass index, fracture position, load sharing score (load-sharing classification, LSC), TLICS score, AO classification, operation time, intraoperative bleeding, postoperative drainage, complications, hospitalization time and cost were compared between the two groups. The anterior edge height of fractured vertebra, cuneiform angle, and visual analog scale(VAS) of low back pain at preoperative, 1 week after operation and final follow-up were measured and compared, and so was the fracture healing time, and time of returning to work. Results: There were no significant differences in age, sex, body mass index, fracture segment, LSC score, TLICS score and AO classification between the two groups(P>0.05). SSPF group was superior to PSFFV group in operation time, postoperative drainage and hospitalization expenses, with significant differences between the two groups(P<0.05). There were no significant differences in intraoperative bleeding and hospitalization time between the two groups(P>0.05), with no serious complications such as intraoperative vascular injury, spinal nerve root injury and postoperative wound infection in both groups. Comparing with that before operation, the cuneiform angle, anterior edge height of fractured vertebra, and VAS score at 1 week after operation were significantly improved(P<0.05), and there were no significant differences in cuneiform angle and anterior edge height between the last follow-up and 1 week after operation (P>0.05), yet VAS score at the final follow-up was significantly different from that at 1 week after operation (P<0.05). There were no significant differences in cuneiform angle, anterior edge height, VAS score between the two groups before operation, at 1 week after operation and last follow-up, and also there were no significant differences in fracture healing and return-to- work time between the two groups(P>0.05). Conclusions: Both posterior short segment fixation with and without inclusion of the fracture level are safe and effective in the treatment of mild to moderate thoracolumbar burst fractures, which can restore and maintain spinal stability.