经伤椎单侧与双侧置钉治疗单节段胸腰段椎体骨折的中期疗效对比  

Comparison of Medium-Term Effects of Unilateral and Bilateral Pedicle Screw Fixation on Thoracolumbar Vertebral Fractures

作　　者：曾会龙 刘家明[2] 陈宣银[2] 龙新华[2] 杨东[2] 段满生[2] 黄山虎[2] 刘志礼[2] ZENG Hui-long LIU Jia-ming CHEN Xuan-yin LONG Xin-hua YANG Dong DUAN Man-sheng HUANG Shan-hu LIU Zhi-li(Department of Orthopaedic Surgery, Jishui County People ＇ s Hospital, Ji＇ an 331600, China Department of Orthopaedic Surgery, the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]吉水县人民医院骨科,江西吉安331600 [2]南昌大学第一附属医院骨科,南昌330006

出　　处：《南昌大学学报（医学版）》2017年第4期57-60,87,共5页Journal of Nanchang University：Medical Sciences

摘　　要：目的对比分析单节段胸腰段椎体骨折采用经伤椎单侧置钉与双侧置钉治疗的中期疗效。方法将88例单节段胸腰段椎体(T11-L2)骨折患者按术中置钉方式不同分为2组:A组46例采用经伤椎单侧置钉治疗,B组42例采用经伤椎双侧置钉治疗,术后随访24~36个月。比较2组的手术时间,术中失血量,术前、术后与末次随访的伤椎前高比(伤椎前缘高度与邻近上下椎体平均高度的比值)、伤椎相邻椎Cobb角及术后并发症发生情况。结果2组患者术后均获随访,平均随访26.4个月。2组患者在手术时间、术中失血量、术后并发症发生率及术前、术后即刻伤椎前高比与伤椎相邻椎Cobb角比较差异均无统计学意义(P>0.05)。A组末次随访与术后即刻伤椎前高比差值、伤椎相邻椎Cobb角差值均较B组显著增加(P<0.05)。结论胸腰段椎体骨折后经伤椎单侧置钉与双侧置钉的临床疗效相当,但末次随访时单侧置钉伤椎前缘高度及伤椎相邻椎Cobb角丢失更明显。Objective To compare the medium-term effects of unilateral and bilateral pedicle screw fixation on thoracolumbar vertebral fractures.Methods A total of 88 patients with thoracolumbar vertebral fractures（T11-L2）were assigned to receive either unilateral pedicle screw fixation（group A,n=46）or bilateral pedicle screw fixation（group B,n=42）.The operative time,intraoperative blood loss and postoperative complications were compared between the two groups.In addition,the ratio of anterior height of fractured vertebra（the ratio of the anterior border height to the average height of the adjacent upper and lower vertebral bodies）and local kyphotic Cobb angle were measured before operation,after operation and at last follow-up.Results Patients were followed up for a mean period of 26.4months（range 24-36months）.There were no significant differences in operative time,intraoperative blood loss,incidence of complications,and the ratio of anterior height of fractured vertebra and local kyphotic Cobb angle between the two groups（P〈0.05）.Compared with group B,the ratio of anterior height of fractured vertebra and local kyphotic Cobb angle significantly increased in group A after operation and at last follow-up（P〈0.05）.Conclusion Unilateral pedicle screw fixation was equivalent to bilateral pedicle screw fixation for the treatment of thoracolumbar vertebral fractures.However,unilateral pedicle screw fixation resulted in greater loss of anterior height of fractured vertebra and local kyphotic Cobb angle than unilateral pedicle screw fixation at the last follow-up.

关 键 词：胸腰椎 骨折 椎弓根螺钉 单侧 双侧 

分 类 号：R683.2[医药卫生—骨科学]