Objective To investigate the thoracolumbar burst fractures with posterior pedicle screw fixation,influence of vertebral pedicle screws or not on the therapeutic effect.Methods A total of 72 patients with thoracolumbar burst fractures were treated in our hospital from March 2014 to March 2010.The final 65 cases were included in the study.According to the patients whether used vertebral pedicle screw,they were divided into pedicle screw fixation group (A group,non vertebral nail,33 cases),and short segment transpedicular screw fixation group (group B,32 cases of vertebral pedicle screw).All patients were followed up for more than 24 months.The perioperative indicators,postoperative complications and correction of the two groups were compared.Results (1) There were no significant differences in operation time,bleeding volume and length of stay between the two groups (P＞0.05).(2) The incision occurred in 1 case of superficial infection after operation in A group,1 case of fracture fixation,screw penetrating the bone cortex in 1 case,the total incidence rate was 9.09％;B group had 1 case of incision infection,1 case of screw penetrating the bone cortex,without internal fixation of fracture,the total incidence rate was 6.25％.There was no significant difference between the two groups (P＞0.05).(3) Cobb and immediate vertebral height in two groups after operation angle correction were similar,with no significant difference (P＞0.05);but 24 months after operation,Cobb angle and vertebral height correction loss rate of B group were significantly lower than those of group A (P＜0.05).Conclusion In the short segment pedicle screw internal fixation for thoracolumbar burst fracture,whether by pedicle screws,the perioperative indicators and immediate postoperative clinical correction effect is similar,but with the postoperative time,the pedicle screws in reducing loss of postoperative correction has obvious advantages.%目的 探讨胸腰椎爆裂性骨折采用后路短节段椎弓根钉内固定手术中,经伤椎置钉与否对疗效的影响.方法 自2010-03-2014-03,共收治胸腰椎爆裂骨折患者72例,最终65例纳入研究对象.根据患者伤椎置钉与否,分为短节段椎弓根钉固定组(A组,伤椎不置钉)33例,与短节段经伤椎椎弓根钉固定组(B组,伤椎置钉)32例.所有患者术后均随访24个月以上,对两组患者的围手术期指标、术后并发症和矫正情况进行对比.结果 (1)两组患者在手术时间、出血量和住院时间方面对比,差异均无统计学意义(均为P＞0.05).(2)A组术后发生切口浅表感染1例,内固定断裂l例,螺钉穿透骨皮质1例,总发生率为9.09％;B组发生切口感染1例,螺钉穿透骨皮质1例,无内固定断裂者,总发生率为6.25％.两组总发生率对比,差异无统计学意义(P＞0.05).(3)两组术后即刻的伤椎高度及Cobb角矫正情况较为相近,无统计学差异(均为P＞0.05);但术后24个月,B组的Cobb角和伤椎高度的矫正丢失率均显著低于A组(P＜0.05).结论 在短节段后路椎弓根钉内固定治疗胸腰椎爆裂骨折时,无论是否经伤椎置钉,其围手术期指标与术后即刻的临床矫正效果相似,但随着术后时间的推移,经伤椎置钉在减少术后矫正度丢失方面有明显优势.
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