后路椎弓根螺钉长节段固定、短节段经伤椎固定及短节段跨伤椎固定对A型胸腰椎骨折的疗效比较  

Comparison of the efficacy of posterior pedicle screw fixation with long segment,short segment transinjured vertebrae and short segment transinjured vertebrae for type A thoracolumbar fractures

作　　者：刘伟[1] 曹爽 倪志豪 单涛 刘颖 LIU Wei;CAO Shuang;NI Zhihao;SHAN Tao;LIU Ying(Department of Orthopedics,the Third Affiliated Hospital of Anhui Medical University,Hefei 230001,China)

机构地区：[1]安徽医科大学第三附属医院骨科,合肥230001

出　　处：《实用医学杂志》2022年第19期2440-2445,共6页The Journal of Practical Medicine

摘　　要：目的本研究比较长节段固定、短节段经伤椎固定和短节段跨伤椎固定治疗胸腰椎骨折患者的临床效果。方法选取2011年7月至2021年7月安徽医科大学第三附属医院收治并诊断为A型胸腰椎骨折的患者73例,治疗方式为长节段固定(A组,n=28),短节段经伤椎固定(B组,n=24)和短节段跨伤椎固定(C组,n=21)。评估指标包括手术时间、术中出血量、VAS评分、ODI评分、Cobb角、伤椎前缘高度比以及Pearce分级。结果平均随访时间为18.9个月。三组患者术后腰痛(VAS评分)、功能表现(ODI评分)、Cobb角和伤椎前缘高度比较术前均得到显著改善,差异有统计学意义(P<0.05),但三组之间的VAS评分、ODI评分和Pearce分级差异无统计学意义(P>0.05)。A组与B、C组手术时间、术中出血量的比较差异有统计学意义(P<0.05)。此外,尽管骨折椎体的Cobb角和伤椎前缘高度比在术后1年得到了显著校正,但C组的校正损失明显大于A组和B组,差异有统计学意义(P<0.05)。结论与长节段固定相比,短节段固定具有手术创伤小的优点。此外,短节段经伤椎固定也能带来与长节段固定一样好的长期畸形校正效果。Objective The aim of the study was to evaluate the clinical efficacy of posterior pedicle screw fixation with long segment,short segment transinjured vertebrae and short segment transinjured vertebrae for type A thoracolumbar fractures.Methods Seventy-three patients with type A thoracolumbar fractures from July 2011 to July 2021 were selected and treated by long-level fixation(Group A,n=28),short-level through fractured verte-brae fixation(Group B,n=24),and short-level across fractured vertebrae fixation(Group C,n=21)respectively.Evaluation indexes included operation time,intraoperative blood loss,VAS scores,ODI,Cobb angles,anterior height ratios of fractured vertebrae,and Pearce classification.Results The average follow-up duration was 18.9 months.Back pain,functional performance,Cobb angles,and anterior height ratios of fractured vertebrae were efficiently improved after surgery(P<0.05).But there was no significant differencein VAS scores,ODI,and Pearce classification among the three groups(P>0.05).There were significant differences in terms of operation time and intraoperative blood loss between group A and group B and C(P<0.05).In addition,although Cobb angles and anterior height ratios of fractured vertebrae were significant corrected at one-year post-operative,the loss of correction in group C was significant larger when compared with that in group A and B(P<0.05).Conclusions Compared with long-level fixation,short-level fixation has an advantage of less operation-related trauma.Moreover,short-level through fractured vertebrae fixation also leads to as good long-term correction of deformity as long-level fixation.

关 键 词：胸腰椎骨折 后路椎弓根螺钉固定 长节段固定 短节段经伤椎固定 短节段跨伤椎固定 

分 类 号：R826.64[医药卫生—临床医学]