后路短节段固定融合与非融合治疗胸腰椎爆裂骨折的比较研究

发布时间：2018-10-20 20:48

【摘要】：目的比较后路短节段椎弓根螺钉固定融合与非融合治疗胸腰椎爆裂骨折的疗效。方法回顾分析2012年2月-2014年2月采用后路短节段椎弓根螺钉固定治疗,并符合纳入标准的57例单节段胸腰椎爆裂骨折患者临床资料,其中27例术中行融合(融合组),30例未行融合(非融合组)。两组患者性别、年龄、致伤原因、受伤至入院时间、骨折节段及分型、神经功能美国脊髓损伤协会(ASIA)分级等一般资料比较,差异均无统计学意义(P0.05),具有可比性。比较两组手术时间、术中失血量、住院时间。摄胸腰椎X线片,测量后凸Cobb角、伤椎高度和运动范围。采用Greenough腰痛评分法和疼痛视觉模拟评分(VAS)评价患者腰部功能恢复情况,参照ASIA分级标准评估神经功能恢复情况。结果与融合组相比,非融合组手术时间缩短、术中失血量减少,差异有统计学意义(P0.05);两组住院时间比较,差异无统计学意义(P0.05)。两组患者均获随访;融合组随访时间为2.0~3.5年,平均3.17年;非融合组为2~4年,平均3.23年。X线片复查示,融合组2例植骨未达融合;其余25例均融合,融合时间12~17周,平均15.6周。术后融合组2例、非融合组1例出现切口相关并发症,其余切口均Ⅰ期愈合。两组术前、术后即刻及末次随访时Cobb角、伤椎高度比较,差异无统计学意义(P0.05)。术后1年(取出内固定物前),两组伤椎运动范围比较,差异无统计学意义(P0.05);非融合组术后1年均出内固定物,融合组术后1年时11例取出内固定物;末次随访时非融合组伤椎运动范围较融合组显著增加,比较差异有统计学意义(P0.05)。末次随访时,融合组与非融合组Greenough腰痛评分法评分、VAS评分以及ASIA分级比较,差异均无统计学意义(P0.05)。结论后路短节段椎弓根螺钉固定治疗胸腰椎爆裂骨折时无需进行融合,以保留伤椎运动功能,缩短手术时间,减少术中失血,避免取髂骨区相关并发症的发生。
[Abstract]:Objective to compare the effect of posterior short-segment pedicle screw fixation and non-fusion in the treatment of thoracolumbar burst fracture. Methods from February 2012 to February 2014, 57 patients with single thoracolumbar burst fractures were treated with posterior short segmental pedicle screw fixation. Among them, 27 cases underwent fusion (fusion group) and 30 cases did not perform fusion (non-fusion group). There was no significant difference between the two groups in sex, age, cause of injury, time from injury to admission, fracture segment and classification, (ASIA) grading of the American Association of Spinal Cord injury (Asci) and so on (P0.05), there was no significant difference between the two groups (P0.05). The operative time, blood loss and hospitalization time were compared between the two groups. X-ray film of thoracolumbar vertebrae was used to measure Cobb angle of kyphosis, height and range of motion of injured vertebrae. Low back pain score (Greenough) and visual analogue pain score (VAS) were used to evaluate the recovery of lumbar function, and the neurological function was evaluated according to the standard of ASIA. Results compared with the fusion group, the operative time and blood loss in the non-fusion group were shortened, the difference was statistically significant (P0.05); there was no significant difference in hospitalization time between the two groups (P0.05). The mean follow-up time was 3.17 years in the fusion group, 2.0-3.5 years in the fusion group, and 3.23 years in the non-fusion group. X-ray examination showed that two patients in the fusion group were not fused and the other 25 cases were fused for 1217 weeks with an average of 15.6 weeks. Postoperative fusion group (2 cases) and non fusion group (1 case) had incision-related complications. There was no significant difference in Cobb angle and the height of injured vertebrae between the two groups before operation, immediately after operation and at the last follow-up (P0.05). 1 year after operation (before removal of internal fixator), there was no significant difference between the two groups in the range of injured vertebrae motion (P0.05). In the non-fusion group, the internal fixation was taken out 1 year after operation, and in the fusion group, the internal fixation was removed in 11 cases at 1 year after operation. At the last follow-up, the range of injured vertebrae in non-fusion group was significantly higher than that in fusion group, and the difference was statistically significant (P0.05). At the last follow-up, there was no significant difference in Greenough low back pain score, VAS score and ASIA score between fusion group and non-fusion group (P0.05). Conclusion there is no need for fusion in the treatment of thoracolumbar burst fractures with posterior short segmental pedicle screw fixation, in order to preserve the motor function of injured vertebrae, shorten the operation time, reduce intraoperative blood loss and avoid the complications associated with iliac bone extraction.
【作者单位】：西南医科大学附属医院脊柱外科;
【分类号】：R687.32

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