胸腰段脊柱骨折患者跨伤椎内固定与经伤椎内固定的治疗效果比较

摘要

ObjectiveTo analyze and compare the efficacy offixation via the injured vertebra versus across the injured vertebraeon patients with thoracolumbar spine fracture.MethodThe study reviewed 76 patients with thoracolumbar spine fracture with differentfixations from August 2013 to January 2015. A total of 37 patients were included in across injured vertebraefixation group and 39 patients were included in via injured vertebraefixation group. The Cobb angle, anterior hight of injured vertebrae, spinal canal occupational ratio were compared between the two groups. In addition, followed up 6 months and compared the spinal cord function recovery by visual analogue scale (VAS) pain assessment.ResultAfter treatment, the Cobb angle, restoration of the anterior hight of the injured vertebrae, spinal canal occupational ratio of the two groups were significantly improved (P<0.05), but the across injured vertebraefixation group improved more (P<0.05). According to 6 months postoperative follow-up, bone graft fusion occurred in 31 patients (83.78%) in across injured vertebraefixation group and in 36 patients (92.30%) in via injured vertebraefixation group (P<0.05). There was no significant difference in VAS pain score between the two groups (P>0.05).Conclusion Compare with pedicle screw across injured vertebraefixation, pedicle screw via injured vertebraefixation has the advantage of high bone graft fusion ratio, better spinal function recovery and worthy of clinical application promotion.%目的：对比分析胸腰段脊柱骨折患者跨伤椎内固定与经伤椎内固定的治疗路径及效果。方法选取本院2013年8月至2015年1月收治的76例胸腰段脊柱骨折患者为研究对象，将其随机分为跨伤椎内固定组（37例）和经伤椎内固定组（39例）。比较两组患者治疗前后Cobb角、伤椎前缘高度、椎管占位等临床指标变化情况。术后随访6个月，采用视觉模拟评分法（VAS）评估两组患者局部疼痛情况，比较两组患者植骨融合情况及脊髓神经功能恢复情况。结果治疗后两组患者Cobb角、伤椎前缘高度、椎管占位情况等临床指标较术前均明显改善，经伤椎内固定组患者各项临床指标改善程度明显优于跨伤椎内固定组（P＜0.05）。术后随访6个月，跨伤椎内固定组患者植骨融合31例（83.78%），经伤椎内固定组植骨融合36例（92.31%），组间比较差异具有显著性（P＜0.05）。经伤椎内固定组患者治疗各时期的VAS评分均稍低于跨伤椎内固定组，但组间比较差异无显著性（P＞0.05）。结论与跨伤椎内固定相比，经伤椎内固定治疗胸腰段脊柱骨折，能够获得更高的植骨融合率，患者脊柱功能恢复良好，值得临床推广应用。