三种伤椎置钉固定胸腰椎爆裂骨折的疗效对比

发布时间：2019-02-16 05:51

【摘要】：[目的]探讨后路不同内固定方式治疗胸腰椎爆裂性骨折的临床疗效。[方法]2009年2月~2015年7月对116例胸腰椎爆裂性骨折患者行后路复位固定手术治疗,按手术方式将患者分为三组,38例采用伤椎椎弓根内置短螺钉(伤椎短钉组),38例采用伤椎椎弓根内置长螺钉(伤椎长钉组),40例后路短节段椎弓根钉内固定伤椎不置螺钉(伤椎无钉组)。[结果]随访9~36个月,平均15.8个月。三组手术前后伤椎前缘高度比、脊柱后凸Cobb角、伤椎椎管矢状径和横截面积比较均有明显改善,差异有统计学意义(P0.01)。术后神经功能状态较术前有显著改善,差异有统计学意义(P0.05)。伤椎短钉组、伤椎无钉组在术后矫正率、术后椎管面积改善率,优于伤椎长钉组,组间比较差异有统计学意义(P0.05)。伤椎短钉组和伤椎长钉组的远期矫正丢失率和内固定失效率均低于伤椎无钉组(P0.05)。三组间神经功能恢复比较差异无统计学意义(P0.05)。术后疼痛评分伤椎短钉组优于伤椎长钉组和伤椎无钉组(P0.05)。术后并发症三组无显著差别。[结论]在后路内固定中增加经伤椎椎弓根内置短螺钉内固定是治疗胸腰椎爆裂性骨折的更有效手段。
[Abstract]:[objective] to investigate the clinical effect of posterior internal fixation for thoracolumbar burst fracture. [methods] from February 2009 to July 2015, 116 patients with thoracolumbar burst fracture were treated by posterior reduction and fixation. According to the operation mode, the patients were divided into three groups. 38 cases were treated with pedicle internal short screw (short screw group). 38 cases were treated with long screw in pedicle of injured vertebrae (long screw group) and 40 cases with internal fixation of short segment pedicle screw in posterior approach (no screw group). [results] Follow-up for 9 ~ 36 months (mean 15.8 months). The anterior height ratio, Cobb angle of scoliosis, sagittal diameter and cross-sectional area of injured vertebral canal were significantly improved in the three groups before and after operation (P0.01). Postoperative neurological function was significantly improved compared with preoperative, the difference was statistically significant (P0.05). The rate of postoperative correction and the improvement rate of postoperative spinal canal area in the short nail group and the non-nail group were better than those in the long nail group. The difference between the two groups was statistically significant (P0.05). The long-term correction loss rate and the internal fixation failure rate of the short nail group and the long screw group were lower than those of the non-nail group (P0.05). There was no significant difference in the recovery of nerve function among the three groups (P0.05). Postoperative pain score of short nail group was better than that of long nail group and no nail group (P0.05). There was no significant difference in postoperative complications among the three groups. [conclusion] it is a more effective method to treat thoracolumbar burst fracture by adding internal fixation of pedicle of injured vertebrae in posterior internal fixation.
【作者单位】：山东巨野县人民医院骨三科;青岛市立医院脊柱外科;
【分类号】：R687.3

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