后路短节段伤椎单侧与双侧置钉内固定治疗胸腰段骨折的疗效分析

摘要

Objective To investigate the vertebral or bilateral pedicle screws posterior short segment fixation for the treatment of thoracolumbar fractures,whether there were differences in the curative effect.Methods From March 2011 to March 2015,respectively used the traditional 4intervertebral screw fixation,vertebral screw fixation 5 and 6 of the three short segment internal fixation for the treatment of thoracolumbar fractures in 97 cases,of which 4 pin (across vertebral fixation) 31cases,control group 5;nail method (vertebral fixation) in 33 cases,unilateral group;6 pin (vertebral bilateral fixation) in 33 cases,bilateral group.The perioperative indicators,surgical complications,the height of the injured vertebra during the last follow-up period and the loss rate of Cobb angle correction were compared among the three groups.Results The operation time,bleeding volume and hospitalization time of three groups were similar (P＞0.05).As to the complications,the control group and the bilateral group had bilateral cortical bone screw wear phenomenon,only the control group occurred in 3 cases of fracture fixation,but the occurrence of complications of the three groups had no statistically significant difference(P＞0.05).And after correction of vertebral height convex Cobb at the last follow-up,the angle loss rate of unilateral and bilateral group were significantly better than the control group (P＜0.05),but there was no statistical difference between the unilateral group and bilateral group (P＞0.05).Conclusion Compared with short segment intervertebral internal fixation,the pedicle screw can effectively improve the postoperative vertebral height and kyphosis loss correction;whether the bilateral or unilateral vertebral pedicle screw,can achieve good effect in operation according to the patients with vertebral pedicle the integrity of the discretion to choose.%目的 探讨单侧与双侧伤椎置钉行后路短节段内固定治疗胸腰椎骨折,其疗效是否有所差异.方法 自2011-03-2015-03,分别采用传统的跨伤椎4钉固定、经伤椎5钉和6钉固定这三种短节段内固定方式治疗胸腰椎骨折共97例,其中4钉法(跨伤椎固定)31例,为对照组;5钉法(伤椎单侧固定)33例,为单侧组;6钉法(伤椎双侧固定)33例,为双侧组.对三组患者的围手术期指标、手术并发症、末次随访期间的伤椎高度与后凸Cobb角矫正丢失率进行对比.结果 三组患者的手术时间、术中出血量、住院时间均相近(P＞0.05);并发症方面,对照组与双侧组均有螺钉穿透骨皮质现象,仅对照组发生3例内固定断裂,但三组的并发症发生率无统计学差异(P＞0.05);在末次随访时的伤椎高度与后凸Cobb角的矫正丢失率方面,单侧与双侧组均显著优于对照组(P＜0.05),但单侧与双侧组的组间两两比较,未见统计学差异(P＞0.05).结论 与跨伤椎的短节段内固定术式相比,伤椎置钉有效改善了术后的伤椎高度与后凸角矫正丢失问题;无论是单侧或双侧伤椎置钉,均可取得较好的疗效,术中可根据患者伤椎的两侧椎弓根完整性酌情选择.