经椎弓根伤椎植骨与伤椎置钉及单纯短节段固定治疗胸腰段骨折回顾性对比研究

摘要

Objective To investigate the difference of clinical effects of transpedicular grafting and vertebral pedicle screw and short segment fixation in the treatment of thoracolumbar fractures. Methods A total of 180 patients with thoracolumbar fractures were chosen and randomly divided into 3 groups, as group A, group B and group C, and each group contained 60 cases. Group A was treated by short segment fixation, group B was treated by vertebral pedicle screw, and group C received treatment of transpedicular grafting. The operation time, intraoperative bleeding volume, anterior vertebral height ratio before and after operation, sagittal Cobb angle and Japanese Orthopaedic Association (JOA) scores were all compared between the three groups. Results The operation time and intraoperative bleeding volume of group B and group C were all significant better than those of group A, and the differences had statistical significance (P<0.05). There was no statistical significance of the difference between group B and group C (P>0.05). The anterior vertebral height ratio before and after operation, sagittal Cobb angle and JOA scores of group B and group C were all better than those of group A, and the differences were statistically significant (P<0.05). There was no statistical significance of the difference between group B and group C (P>0.05). Conclusion Compared with transpedicular grafting and short segment fixation, vertebral pedicle screw in the treatment of thoracolumbar fractures has the advantages of simple operation and minimally invasion, and can efficiently improve the fixation stability in order to avoid the postoperative excessive loss of corrective angle and improve the function of lumbar vertebrae.%目的：探讨经椎弓根伤椎植骨与伤椎置钉及单纯短节段固定治疗胸腰段骨折临床效果差异。方法180例胸腰段骨折患者以随机抽样方法分为A、B和C三组，每组60例，分别采用单纯短节段固定，伤椎置钉及椎弓根伤椎植骨治疗；比较三组患者手术时间，术中出血量，手术前后伤椎前缘高度比、Cobb矢状面角度及日本整形外科学腰椎疾患治疗成绩(JOA)评分等。结果 B、C组患者手术时间和术中出血量均显著优于A组，差异有统计学意义(P<0.05)；但B、C两组患者手术时间和术中出血量比较，差异无统计学意义(P>0.05)；B、C两组患者术后伤椎前缘高度比、Cobb矢状面角度及JOA评分均显著优于A组，差异有统计学意义(P<0.05)；但B、C两组患者术后伤椎前缘高度比、Cobb矢状面角度及JOA评分比较，差异无统计学意义(P>0.05)。结论相较于单纯短节段和经椎弓根伤椎植骨短节段固定治疗，伤椎置钉短节段固定治疗胸腰段骨折手术具有操作简便，微创等优点，有助于改善固定稳定程度，避免术后矫正角度过度丢失，并提高腰椎活动功能。