经伤椎双节段与跨伤椎短节段固定治疗胸腰椎骨折3年以上随访结果  

More than 3 years' follow-up results of transvertebral pedicle screws fixation and posterior short-segmental fixation for thoracolumbar fracture

作　　者：刘新民[1] 李悦[1] 管波清[1] 刘书茂[1] 

机构地区：[1]北京市大兴区人民医院骨科,北京102600

出　　处：《临床骨科杂志》2016年第3期274-278,共5页Journal of Clinical Orthopaedics

摘　　要：目的：比较经伤椎双节段固定与跨伤椎短节段固定治疗胸腰椎骨折的中期随访结果。方法对63例经伤椎双节段与跨伤椎短节段固定治疗并获得3年以上随访的胸腰椎骨折患者的资料进行分析。比较两组患者的手术时间及术中出血量；测量术前、术后3d和末次随访时伤椎及其上下相邻正常椎体的前缘高度、伤椎后凸Cobb角，比较两组的椎体前缘高度比、末次随访矫正度丢失情况。结果跨伤椎短节段固定组的手术时间和术中出血量明显少于经伤椎双节段固定组（P＜0.05）。患者均获得随访，时间37～77（52.8±11.5）个月。末次随访时患者满意率：经伤椎双节段固定组为90.3％、跨伤椎短节段固定组患者为84.4％（ P ＜0.05）。术后两组患者椎体前缘高度及Cobb角较术前均显著恢复（ P＜0.05）。末次随访时，经伤椎双节段固定组对椎体前缘高度和矢状面Cobb角的保持优于跨伤椎短节段固定组（P＜0.05）。结论经伤椎双节段固定术及跨伤椎短节段固定术都能较好地恢复胸腰椎骨折的椎体高度和Cobb角。经伤椎双节段固定术对术后矫正度的保持优于跨伤椎短节段固定术，但手术时间相对较长、出血量相对较多。Objective To compare the clinical outcomes of transvertebral pedicle screws fixation and posterior short -segmental fixation for thoracolumbar fracture .Methods 63 patients with thoracolumbar burst fracture underwent transvertebral pedicle screws fixation or posterior short-segmental fixation and had at least 3 years′follow-up.The op-eration time and blood loss of the two groups were compared .The anterior height of the injured vertebrae was as well as the adjacent two normal vertebraes , and Cobb angle of the injured vertebrae were measured at the preoperative , 3 days postoperation , last follow-up.The compression rate and the loss of correction of the two groups were compared . Results Compared with the transvertebral pedicle screws fixation group , the posterior short-segmental fixation group had less loss of blood loss and shorter duration of operation time （ P〈0.05 ） .All patients were followed up , and the follow-up time was 37-77（52.8 ±11.5） months.At the final follow-up, the satisfaction rate was 90.3%for trans-vertebral pedicle screws fixation group and 84.4%for posterior short-segmental fixation group（P〈0.05）.The com-pression rate and the Cobb angle were significantly restored after the surgery , but the transvertebral pedicle screws fix-ation group had a better maintainance of correction compared with posterior short -segmental fixation group at the final follow-up（P〈0.05）.Conclusions For thoracolumbar fracture, both transvertebral pedicle screws fixation and pos-terior short-segmental fixation can restore the vertebral height and Cobb angle well , but the first group has a better maintainance of correction .The posterior short-segmental fixation group has a shorter operation time and less loss of blood.

关 键 词：胸腰椎骨折 经伤椎固定 跨伤椎短节段固定 

分 类 号：R683.2[医药卫生—骨科学] R687.3[医药卫生—外科学]