采用经伤椎固定与跨伤椎短节段固定治疗胸腰椎骨折效果的对比分析  

Short-segment fixation via versus across the injured vertebrae for thoracolumbar vertebral fractures

作　　者：吴建明[1] 刘向阳[1] 胡伟[1] 袁建华[1] 

机构地区：[1]安徽省亳州市人民医院骨二科,亳州236800

出　　处：《医学研究生学报》2015年第8期843-846,共4页Journal of Medical Postgraduates

摘　　要：目的伤椎置钉固定技术是目前临床治疗胸腰椎骨折最为常用的方法之一。文中对比研究胸腰椎骨折经伤椎与跨伤椎短节段固定治疗的临床疗效。方法回顾性分析2011年3月至2013年1月胸腰段椎体骨折行手术治疗的75例患者的临床资料,根据不同的手术入路分为2组:经伤椎组(经伤椎椎弓根置钉4钉单节段固定手术治疗)39例和跨伤椎组(跨伤椎短节段固定手术治疗)36例。比较2组患者术前、术后3 d与末次随访的伤椎椎体前缘高度比、矢状面Cobb角及手术时间、术中出血量。结果经伤椎组、跨伤椎组术前椎体前缘高度比分别为(56.32±12.53)%和(57.67±13.81)%,矢状面Cobb角分别为(20.41±5.73)°和(19.87±5.76)°;术后椎体前缘高度比分别为(85.76±11.48)%和(83.51±12.54)%,矢状面Cobb角分别为(8.72±5.34)°和(9.18±5.42)°,同组术后与术前比较差异均有统计学意义(P<0.05)。末次随访时,跨伤椎组椎体前缘高度、矢状面Cobb角分别为(76.82±11.06)%,(15.42±6.14)°,与术后比较差异有统计学意义(P<0.05);经伤椎组椎体前缘高度、矢状面Cobb角分别为(81.74±10.38)%,(10.93±6.32)°,与跨伤椎组比较差异有统计学意义(P<0.05)。2组患者的手术时间和术中出血量比较,差异均无统计学意义(P>0.05)。跨伤椎组患者的椎体前缘高度比丢失(6.69±2.52)%、Cobb角矫正丢失(6.31±2.18)°,明显高于经伤椎组[(3.78±1.24)%、(2.25±1.06)°],差异有统计学意义(P<0.05)。结论经伤椎与跨伤椎短节段固定治疗胸腰椎骨折均能够很好的改善椎体的前缘高度比和矢状面Cobb角,但经伤椎椎弓根置钉4钉单节段固定方法能够更好地降低术后矫正度的丢失。Objective Short-segment fixation is one of the most commonly used methods for the management of thoracolumbar vertebral fractures. In this study, we compared the clinical effects of short-segment fixation via and across the injured vertebrae in the treatment of thoracolumbar vertebral fractures. Methods We retrospectively analyzed 75 cases of thoracolumbar vertebral fractures treated by short-segment fixation, 39 via the injured vertebrae （group A） and 36 across the injured vertebrae （group B）. We obtained the pre- and pest -operative anterior vertebral body height ratio （AVBHr） and sagittal Cobb angle, operation time, and intraoperative blood loss, and compared them between the two groups of patients. Results Compared with the baseline, the AVBHr and the sagittal Cobb angle were significantly restored after surgery in both groups A （ [ 56.32 ± 12.53 ] vs [ 85.76 ± 11.48 ] % and [ 20.41 ± 5.73 ] vs [8.72 ±5.343], P〈0.05） and B （[57.67 ±13.81] vs [83.51 ±12.543% and [19.87±5.76] vs [9.18 ±5.42]°, P〈0.05）. The last follow- up examinations showed the AVBHr and Cobb angle to be （81.74 ± 10.38）% and （10. 93 ± 6.32）° in group A and （76.82± 11.06）% and （15.42 ± 6. 14） ° in group B （P 〈 0.05 ）, with statistically significant differences from the postoperative parame- ters in group B （P 〈 0.05）. However, no remarkable differences were found between the two groups in the operation time or intraopera- tive blood loss （P 〉 0. 05 ）. The losses of the AVBHr and Cobb angle were （3.78 ± 1.24 ）% and （2.25 ± 1.06）° in group A, signifi-cantly lower than （6.69 ±2. 52）% and （6.31±2. 18）° in group B （P 〈0. 05 ）. Conclusion For thoracolumbar fractures, short- segment fixation either via or across the injured vertebrae can effective-ly improve the vertebral height and Cobb angle, but fixation via the injured vertebrae may achieve a better maintenance of correction.

关 键 词：胸腰椎骨折 椎体前缘高度比 COBB角 经伤椎单节段固定 跨伤椎固定 

分 类 号：R683[医药卫生—骨科学]