伤椎置钉结合短节段椎弓根螺钉固定治疗胸腰椎骨折  

Unilateral versus bilateral pedicle fixation at the level of fracture in the treatment of thoracolumbar fractures with mild to moderate instability

作　　者：曾至立[1] 程黎明[1] 李山珠[2] 于研[1] 贾永伟[1] 王建杰[1] 胡笑[1] 徐委[1] 

机构地区：[1]同济大学附属同济医院脊柱外科,上海200065 [2]新疆医科大学第二附属医院骨科

出　　处：《中华医学杂志》2013年第27期2117-2121,共5页National Medical Journal of China

基　　金：国家自然科学基金项目（30973034）;新疆科技厅科技支疆项目（201233148）

摘　　要：目的比较单侧伤椎置钉或双侧伤椎置钉结合短节段椎弓根螺钉固定治疗胸腰椎骨折的手术疗效。方法回顾性分析2008年6月至2010年9月收治的46例载荷分享评分（LSC）为5～7分胸腰椎骨折患者进行伤椎固定结合短节段椎弓根螺钉固定的临床资料，按照伤椎单侧或双侧置钉数分为5钉组及6钉组，5钉组25例，6钉组21例。依据患者伤椎前缘高度比（AVHC）、矢状面Cobb角、内固定失败率、神经功能恢复、疼痛视觉模拟评分（VAS）及Oswestry功能障碍指数（ODI）进行评价，对两组数据进行统计学分析比较。结果两组患者性别、年龄、损伤节段、LSC、AVHC及矢状面Cobb角差异均无统计学意义（均P〉0．05），5钉组的手术时间（109．2±30．7）min及术中出血量（376．0±303．1）ml，6钉组的手术时间（110．0±32．1）min及术中出血量（409．5±361．1）ml，差异无统计学意义（t=-0．086，-0．342，P〉0．05）。所有病例随访1年以上，5钉组（17．5±4．1）个月，6钉组平均（18．3±4．3）个月，两组之间差异无统计学意义（t=-0．683，P〉0．05）。术前有部分神经功能损害者均获得恢复。两组均获得满意的放射学及功能学评价，末次随访时5钉组AVHC（93．0％±3．0％），Cobb角（2．6±5．6）°，VAS（1．4±1．0），ODI（17．2±7．8）；6钉组AVHC（93．1％±2．74％），Cobb角（3．2±5．4）°，VAS（1．6±1．0），ODI（16．7±5．8）；两组间差异无统计学意义（t=-0．159，-0．390，-0．688，-0．235，P〉0．05）。结论对于载荷分享评分在5—7分胸腰椎骨折进行伤椎置钉结合短节段椎弓根螺钉固定安全有效，单侧伤椎置钉能获得和双侧伤椎置钉相同疗效。Objective To evaluate the efficacies of unilateral versus bilateral pedical screw fixation through the pedicle of fractured vertebra plus short-segment pedicle instrumentation （SSPI） in the treatment of thoracolumbar fractures. Methods Between June 2008 and September 2010, a total of 46 patients with fractures of thoracolumbar junction, whose scores of load sharing classification （LSC） ranging from 5 to 7, underwent the combined treatment of SSPI and fracture level pedicle screw at our department. They were divided into 2 groups. Group I included 25 patients undergoing SSPI plus unilateral pedicle screw fixation through the pedicle of fractured vertebra （5 screws） while Group lI included 21 patients had SSPI plus bilateral pedicle screw fixation through the pedicle of fractured vertebra （6 screws）. The data of anterior body height compression （AVHC）, sagittal Cobb＇s angle, internal fixation failure, restoration of nervous function, visual analogue score （VAS） and Oswestry disability index （ODI） were analyzed. Results The groups were similar with regards to age, gender, LSC, AVHC and sagittal Cobb＇s angle preoperatively. Blood loss volume and operative duration were less in the Group I （ 109.2 ± 30. 68 vs 110. 0 ± 32.06 rain, t= -0.086, P〉0.05 and 376.0 ＋303.1 vs 409.5 ±361.1 ml, t = -0.342, P〉0.05）. They were followed up for a minimum period of 12 months. In follow-up period was 17.48 ±4. 14 months in Group I versus 18.33± 4. 31 months in Group I1 （ t = - 0. 683, P 〉 0. 05 ）. All patients with initial partial neurologic deficits improved at the final follow-up. Radiographic parameters and clinical outcomes were similar in both groups. Conclusions Pedical screw fixation through the pedicle of fractured vertebra plus SSPI is an excellent surgical therapeutic choice for patients with a LSC range of 5-7 thoraelumbar fractures. The effieacies of unilateral and bilateral pedicle screw fixation at fracture level are the same.

关 键 词：骨折固定术 脊柱骨折 胸椎 腰椎 载荷分享评分 

分 类 号：R687.3[医药卫生—骨科学]