后路伤椎置钉与跨节段椎弓根螺钉内固定术治疗胸腰椎骨折的临床疗效比较

摘要

目的 比较后路伤椎置钉与跨节段椎弓根螺钉内同定术治疗胸腰椎骨折的临床疗效,优化胸腰椎骨折的治疗方案.方法 将60例符合入组标准的胸腰椎骨折患者按随机数字表分为后路伤椎置钉组30例与跨节段椎弓根螺钉内固定术组30例,分别进行后路伤椎置钉内固定治疗及跨节段椎弓根螺钉内固定治疗,所有患者均随访1年,治疗前及随访末期进行影像学检查,比较两组患者术中出血量,随访期间比较术后矫正率、后凸Cobh角、术后椎管面积改善值、远期丢失率、椎管占位情况、内固定失败率.结果 后路伤椎置钉内同定与跨节段椎弓根螺钉内固定的术中出血量、凸Cobb角、术后矫正率、术后椎管面积改善值、远期丢失率、内固定失败率、椎管占位分别为(1245±221) ml比(873±145) ml,(10.4±6.7)°比(20.8±8.3)°,(97.6±1.8)％比(82.5±5.4)％,(44.3±2.3)％比(28.5±2.2)％,(1.4±11)％比(9.6±2.8)％,(4.1±1.1)％比(1 1.7±2.6)％,各项指标差异具有统计学意义(P＜0.05).结论 后路伤椎置钉较跨节段椎弓根螺钉内固定能提高胸腰椎骨折复位质量,增强内固定系统的牢固性,并利于矫正后凸畸形和维持矫正效果,且可降低远期并发症发生率,是治疗胸腰椎骨折的理想方法.%Objective To compare the clinical efficacy of posterior fractured vertebral pedicle screws and posterior short segment pedicle instrumentation in the treatment of tboracolumbar fractures,to optimize the treatment of thoracolumbar fractures.Methods 60 patients with thoracolumbar fractures meeting the inclusion criteria were randomly divided into posterior fractured vertebral pedicle screws group with 30 cases and posterior short segment pedicle instrumentation group with other 30 cases,and all patients were given fractured vertebra by posterior approach and posterior short segment pedicle instrumentation,and were followed up for one year,and given imaging study before and after treatment,the blood loss,correction rate of postoperative follow-up period,kyphosis Cobb angle,spinal canal area to improve the value of long-term loss ofrate,canal compromise situation and internal fixation failure rate were compared.Results The blood loss,correction rate of postoperative follow-up period,kyphosis Cobb angle,spinal canal area to improve the value of long-term loss ofrate,canal compromise situation,internal fixation failure rate between posterior fractured vertebral pedicle screws group and posterior short segment pedicle instrumentation group were (1245 ± 221) ml vs (873 ± 45) ndl,(10.4 ± 6.7)° vs (20.8 ± 8.3)°,(97.6 ± 1.8)％ vs (82.5 ± 5.4)％,(44.3 ± 2.3)％ vs (28.5 ± 2.2)％,(1.4 ± 1.1)％ vs (9.6 ± 2.8)％,0/0％ vs 4/13.33％,(4.1 ± 1.1)％ vs (11.7 ± 2.6)％ respectively,the indicators differences were statistically significant,P ＜ 0.05 or P ＜ 0.01.Conclusion The posterior fractured vertebral pedicle screws can improve the quality of thoracolumbar fractures,enhance fixation system securely and it' s conducive to correct kyphosis and maintain the corrected results,and it can reduce incidence of long-term complications,which is the ideal method for treatment of thoracolumbar fractures.