胸腰椎爆裂性骨折经后路不同手术方法治疗

摘要

目的:比较单纯经椎弓根复位内固定、经椎弓根内固定与椎体成形治疗胸腰椎爆裂性骨折的效果.方法:对97例胸腰椎爆裂性骨折患者采用单纯经椎弓根复位内固定术治疗(A组)43例,经椎弓根内固定与椎体成形术治疗(B组)54例,通过X摄线片及CT检查,以及ASIA神经功能评定标准评价手术疗效.结果:97例经12个月～9年3个月,平均2年7个月时间随访,A、B两组Cobb角、椎体前缘高度、椎体后缘高度、椎管狭窄率术后与手术前比较有显著性差异(P＜0.001);组间比较无统计学意义,但随访时期上述观察项目B组明显优于A组.神经功能按ASIA评价,全组病例均有1～2级的恢复.结论:两种手术方法早期均可获得满意的效果,但经椎弓根内固定与椎体成形术具有骨诱导能力,可以促进骨折愈合,维持脊椎的持久稳定,减少并发症发生.%Objective To compare the clinical effect between the simple pedicle of vertebral arch fixation and the combination pedicle of vertebral arch fixation with vertebral plasty for thoracolumbar burst fractures.Methods Forty-three patients with thoracolumbar burst fractures were treated by simple pedicle of vertebral arch fixation(group A); 54 patients were treated by combination pedicle of vertebral arch fixation with vertebral plasty (group B).The clinical effects were evaluated by imaging examination and ASIA criteria.Results Ninety-seven patients were followed up for 12 to 113 months averaged 31 months.Compared with those of pre-operation, the post-operation Cobb and angle degree, vertebral anterior and posterior border height and the rate of spinal stenosis were significantly different in A and B group respectively (P ＜ 0.01).These parameters were not significantly different between the two groups.The loss rate of Cobb angle degree, vertebral anterior and posterior border height and the recovery rate of spinal stenosis was significantly higher during follow-up term in group A than those in group B.The nerve function was increased by 1 to 2 grade in all patients according to ASIA criteria.Conclusion The clinical effects are satisfactory in both groups.But the method of combination pedicle of vertebral arch fixation with vertebral plasty showed the advantages of : bone induction activity, promoting fracture healing, maintaining vertebral persistent stability and reducing morbidity.