经伤椎椎弓根置钉四钉短节段固定法在无神经损伤胸腰椎骨折治疗中的临床效果研究

摘要

Objective To choose more reasonable treatment methods by comparing the clinical efficacy of fractured vertebral pedicle screw placement tetrabutylammonium short segment fixation and cross-fractured vertebral four nailing method treating non-nerve injury thoracolumbar fractures. Methods 92 patients with non-nerve injury thoracolumbar fractures were divided into control and observation group randomly with 46 patients in each group, all the patients received paraspinal muscle gap approach surgery, besides, patients in control group received cross-fractured vertebral four nailing method and in observation group received fractured vertebral pedicle screw placement tetrabutylammonium short segment fixation. All the patients were followed up by more than 12 months, the treatment outcome were evaluated, the thoracic lumbar restore situation were analyzed and compared. Results Of thepatients in two groups, VAS and DOA scores after surgery were all lower than that before surgery significantly (P<0.05), Cobb angle in 3 days,3 months and a year after surgery were lower than that before surgery, anterior height of the fractured vertebral after surgery were higher than before surgery significantly(P<0.05), Cobb angle in 3 days,3 months and a year after surgery of patients in observation group were lower than patients in control group, anterior height of the fractured vertebral patients in observation group were higher than patients in control group(P<0.05). Conclusions Both fractured vertebral pedicle screw placement tetrabutylammonium short segment fixation and cross-fractured vertebral four nailing method have a certain efficacy in treating non-nerve injury thoracolumbar fractures, and fractured vertebral pedicle screw placement tetrabutylammonium short segment fixation is more conducive to maintaining long-term stability of the patient's spine.%　　目的比较经伤椎椎弓根置钉四钉短节段固定法与跨伤椎四钉固定法在无神经损伤胸腰椎骨折治疗中临床效果，旨在选择更合理的治疗方式。方法将我院收治的92例无神经损伤胸腰椎骨折患者随机分为对照组和观察组，每组46例，全部患者均予以椎旁肌间隙入路手术，对照组采取跨伤椎四钉固定法，观察组采取经伤椎椎弓根置钉四钉短节段固定法。对全部患者进行12个月以上的随访，对全部患者的手术治疗效果进行评价，并对两组患者术后胸腰椎恢复情况进行比较分析。结果两组患者治疗后的 VAS 评分和 DOA 显著低于治疗前（P＜0.05），两组患者术后3d、术后3个月及术后1年的Cobb角显著低于术前，伤椎前缘高度比显著高于术前，差异具有统计学意义（P ＜0.05）。而观察组术后3d、术后3个月及术后1年的 Cobb 角显著低于同期对照组患者，而伤椎前缘高度比显著高于同期对照组患者，差异具有统计学意义（P ＜0.05）。结论经伤椎椎弓根置钉四钉短节段固定法与跨伤椎四钉固定法在治疗胸腰椎骨折中存在一定的临床疗效，但经伤椎椎弓根置钉四钉短节段固定法术更有利于维持患者脊柱的长期稳定作用。