单节段A型胸腰段骨折短节段经伤椎固定同长节段跨伤椎固定的近期疗效分析  

Analysis of recent effect of short-segmental trans-vertebral fixation and longsegmental cross-vertebral fixation for mono-segmental thoracolumbar compression fracture

作　　者：高翔[1,2] 张旭鸣[1,2] 何武兵[1,2] 林昊[1,2] 许玮[1,2] GAO Xiang;ZHANG Xu-min;HE Wu-bin;LIN Hao;XU Wei(Department of Emergency Surgery,Fujian Provincial Hospital,Fuzhou 350001,China;Clinical Medical College of Fujian Provincial Hospital,Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建省立医院急诊外科,福州350001 [2]福建医科大学省立临床医学院,福州350001

出　　处：《创伤与急诊电子杂志》2018年第2期101-106,共6页Journal of Trauma and Emergency(Electronic Version)

摘　　要：目的探讨单节段胸腰椎骨折应用短节段经伤椎固定同长节段跨伤椎固定的疗效。方法对本院于2014年5月至2016年10月收治的45例单节段A型胸腰段骨折患者(无脊髓神经损伤)行随访调查研究,根据最终手术方式将患者分为短节段组(n=21)和长节段组(n=24)。短节段组患者采用短节段经伤椎固定的手术方式,长节段组患者采用长节段跨伤椎固定的手术方式。比较两组患者手术治疗前后伤椎高度压缩率、Cobb角度、日本骨科协会评估治疗分数(Japanese Orthopaedic Association, JOA)、视觉模拟评分(visual analogue score, VAS)。结果 45例患者术后随访10个月到3年,平均20个月,两组患者术后Cobb角度、伤椎高度压缩率较术前降低,差异有统计学意义(P <0.01),术后JOA评分高于术前,差异有统计学意义(P <0.01)。术后短节段组患者的Cobb角度(7.3±1.9)°低于长节段组(10.1±2.5)°,差异有统计学意义(t=3.635,P <0.01);短节段组患者的伤椎高度压缩率(9.1±2.6)%低于长节段组(13.2±3.5),差异有统计学意义(t=3.725,P <0.01);短节段组患者的JOA评分(24.22±2.36)分,高于长节段组(21.36±3.88)分,差异有统计学意义(t=3.556,P <0.01);两组患者VAS评分差异无统计学意义(t=2.553,P> 0.01)。结论采用经伤椎置钉短节段固定较长节段跨伤椎固定术后近期伤椎高度丢失少,并发症发生率低,术后患者满意度较高。Objective To investigate the effect of short-segmental trans-vertebral fixation and long-segmental cross-vertebral fixation for the treatment of mono-segmental thoracolumbar compression fracture. Methods Patients were divided into the short segment group （n=21） and the long segment group （n=24）. According to the final surgical approach, patients in the short segment group were treated with trans-vertebral fixation, and those in the long segment were treated with cross-vertebral fixation. The injury vertebral height compression ratio, Cobb angle, Japanese Orthopaedic Association（JOA） score and visual analogue score （VAS） were compared between the two groups before and after surgery. Results Forty-five patients were followed up for an average of 20 months （10 months to 3 years） after surgery. All of the postoperative patients’JOA scores and Cobb angle were significantly improved（P 〈 0.01）. The Cobb angle and the compression rate of vertebral height after operation were reduced in the two groups, and the difference was statistically significant （P 〈 0.01）. There was no significant difference in VAS score between the two groups（P 〉 0.01）.Conclusion Compared with long-segmental cross-vertebral fixation, vertebral height loss may be less severe, the incidence of complications lower, and the postoperative patient satisfaction higher after short-segmental trans-vertebral fixation.

关 键 词：胸腰段骨折 短节段经伤椎固定 长节段跨伤椎固定 Cobb角度 JOA评分 VAS评分 

分 类 号：R687.3[医药卫生—骨科学]