伤椎置钉与不置钉短节段内固定治疗胸腰椎爆裂骨折的比较  

Posterior short-segment fixation with or without pedicle screw for treating thoracolumbar burst fractures

作　　者：刘潮坚[1] 蔡拉加[1] 石昭宏[1] 林剑雄[1] 

机构地区：[1]广东省潮州市中心医院骨外科,广东潮州521000

出　　处：《中国矫形外科杂志》2016年第6期531-535,共5页Orthopedic Journal of China

摘　　要：[目的]比较伤椎置钉与传统伤椎不置钉后路短节段固定治疗胸腰椎爆裂性骨折的临床疗效及影像学结果。[方法]2009年2月～2013年2月共70例患者纳入本研究,根据伤椎是否置钉将患者分为置钉组（采用短节段椎弓根螺钉固定伤椎上下椎体,联合伤椎置钉,33例）和不置钉组（采用短节段椎弓根螺钉固定伤椎上下椎体,而伤椎不置钉,37例）。比较两组患者手术时间、出血量（术中失血量＋术后引流量）、住院天数、围手术期并发症、术后24个月时Oswestry功能障碍指数（ODI）、术后伤椎高度矫正率术后24个月伤椎高度矫正丢失率、术后Cobb角矫正率及术后24个月Cobb角矫正丢失率。[结果]两组患者手术时间、出血量、住院天数、术后并发症发生率、术后伤椎高度矫正率、术后Cobb角矫正率及术后24个月ODI等比较差异无统计学意义（P〉0.05）,但两组患者术后24个月伤椎高度矫正丢失率及术后24个月Cobb角矫正丢失率比较差异有统计学意义（P〈0.05）。[结论]短节段椎弓根螺钉治疗胸腰椎爆裂性骨折,伤椎置钉与伤椎不置钉,临床疗效相似,但是伤椎置钉能够有效恢复并维持椎体高度、减少术后后凸畸形矫正丢失,是治疗胸腰椎爆裂性骨折的适宜选择。[ Objective ] To compare clinical and radiographic results of posterior short - segment fixation system with or without pedicle screw in the treatment of thoracolumbar burst fractures. [ Method ] A total of 70 patients were included in this study from February 2009 to February 2013, patients were divided to fixation with screw group（ posterior short - segment fixation at the level of fracture, n = 33 ） and fixation without screw group（ posterior short -segment fixation but without pedicle screw, n = 37）. Indicators were recorded and compared between two groups, including operative time, blood loss, length of hospital stay, perioporative eomplications,Oswestry Disability Index（ODI） at 24 months after surgery,postoperative vertebral height correction rate, corrected vertebral height loss rate at 24 months after surgery, postoperative Cobb angle correction rate, and Cobb angle cor- rection loss rate at 24 months after surgery. [ Result] There was not significant differences between the two groups in term of op- erative time, blood loss,length of hospital stay, perioperative complications, ODI at 24 months after surgery, postoperative verte- bral height correction rate, and postoperative Cobb angle correction rate（P 〉 0.05 ）. However, there were significant differences in term of corrected vertebral height loss rate at 24 months after surgery, and Cobb angle correction loss rate at 24 months after surgery（P 〈 0.05 ）. [ Conclusion] Both posterior short- segment fixation system with and without pedicle screw can achieve similar clinical outcomes. However, the short -segment pedicle screw fixation plus pedicle screw fixation at the level of fracture is effective to maintain the reduction and reduce the rate of correction loss,which is a better choice for treatment of thoracolum- bar burst fractures.

关 键 词：胸腰椎骨折 骨折内固定 短节段椎弓根螺钉固定系统 

分 类 号：R687.3[医药卫生—骨科学]