后路复位内固定术治疗LSC评分为7分和8分胸腰段爆裂性骨折的疗效评价

Evaluation of the efficacy of posterior reduction and internal fixation for thoracolumbar burst fractures with Load-sharing classification score of 7 and 8

中文关键词:  胸腰椎爆裂性骨折  载荷分类评分系统  安全性评价  后路复位内固定手术

英文关键词:Thoracolumbar burst fracture  Load-sharing classification  Safety evaluation  Posterior reduction and internal fixation

中文摘要:

  【摘要】 目的：探讨后路复位内固定术治疗脊柱载荷分类评分系统（Load-sharing classification，LSC）评分为7分和8分胸腰段爆裂性骨折患者的临床疗效及安全性。方法：回顾分析2009年10月～2014年12月36例LSC评分为7分及8分行后路复位内固定手术方案的患者资料，其中男21例，女15例，年龄21～67岁，平均42.67±14.67岁，骨折椎体为T12～L1。影像学资料包括X线、CT和MRI，并进行LSC评分。测量患者术前、术后（1周内）及末次随访时的伤椎Cobb角、伤椎椎体高度，末次随访时使用疼痛视觉模拟评分（visual analogue scale，VAS）评估残余背部疼痛，并记录手术并发症，进行安全性评价。结果：所有病例随访时间23～86个月，平均49.83±18.20个月；末次随访时19例已取出内固定，内固定取出后继续随访时间为3～69个月，平均28.00±20.12个月。临床评估所有患者均骨折愈合，患者均无明显的残余疼痛，未出现断钉或断棒，均未出现明显的后凸畸形，均未出现椎弓根钉切割椎体或内固定松动。影像学评价，术后患者矢状面Cobb角（6.67°±5.06°）较术前（15.87°±8.35°）有显著改善，骨折椎体前缘高度由术前的1.81±0.49cm恢复至术后2.88±0.32cm，差异均有统计学意义（P<0.05）。末次随访时椎体高度为2.81±0.41cm，术后与末次随访椎体高度之间比较差异无统计学意义（P>0．05）。末次随访时，所有患者神经功能状况均较受伤时得到恢复，无椎间隙高度丢失，椎体前缘高度恢复至（94.92±18.41）%，椎体中部高度恢复至（81.16±11.82）%，椎体后缘高度恢复至（97.48±7.63）%，与术前比较差异均有统计学意义（P<0.05）。结论：LSC评分为7分及8分胸腰椎爆裂性骨折患者行后路复位内固定手术椎体稳定性维持良好，安全性好，临床疗效和影像学结果满意。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical efficacy and safety of posterior reduction and fixations in patients with thoracolumbar burst fractures with Load-sharing classification(LSC) score of 7 and 8 points. Methods: The data of 36 patients with LSC score of 7 and 8 who underwent posterior reduction and internal fixation between October 2009 and December 2014 were retrospectively analyzed. There were 21 males and 15 females, with an average age of 42.67±14.67 years(range 21 to 67 years). The fractured vertebrae were T12-L1. LSC score was graded according to the imaging data including X-ray radiographs, CT and MRI. The index vertebral Cobb angle and anterior vertebral height were collected at preoperative, postoperative 1 week and final follow-up, respectively. Visual analogue scale(VAS) was used to evaluate residual back pain at final follow-up. The complications were recorded for safety evaluation. Results: All the patients were followed up for 49.83±18.20 months on average(23-86 months), of which 19 cases had internal fixations removed, and the follow-up period for patients after internal fixation removal was 28.00±20.12 months on average(3-69 months). Fracture healing was achieved in all the patients without significant residual pain, or broken screw or rod, or significant kyphosis, or pedicle screw cutting vertebral body or loosening of the internal fixation. For imaging evaluation, the postoperative sagittal Cobb angle was significantly improved to 6.67°±5.06° from the preoperative 15.87°±8.35°, and the postoperative height of anterior margin of the fractured vertebral body recovered to 2.88±0.32cm from 1.81±0.49cm before operation, all with statistically significant differences(P<0.05). The vertebral body height at the final follow-up was 2.81±0.41cm, and there was no statistically significant difference between postoperative and the final follow-up vertebral body heights(P>0.05). At the final follow-up, the neurological functions of all the patients recovered compared with the conditions at the time of injury, with no loss of intervertebral space height. The anterior edge height of the vertebral body recovered to (94.92±18.41)%, the middle edge height recovered to (81.16±11.82)%, and the posterior edge height recovered to (97.48±7.63)%, all with significant differences compared to those before surgery(P<0.05). Conclusions: The posterior reduction and internal fixation for patients with thoracolumbar burst fracture with LSC scores of 7 and 8 can achieve good preservation of vertebral stability at later stage, high safety, and satisfactory clinical efficacy and imaging results.