目的 分析胸腰椎骨折治疗中跨伤椎置钉与伤椎置钉术对临床疗效及Oswestry功能障碍评分的影响.方法 选取收治的因胸腰椎骨折需进行内固定的患者42例.按照患者的伤椎置钉方式进行分组,21例使用伤椎置钉术的患者为甲组,21例使用跨伤椎置钉术的患者为乙组.患者术后均随访1年,比较2组患者围术期相关指标、手术前后伤椎前缘高度和Cobb角,以及术后1年Oswestry功能障碍评分情况.结果 甲组患者手术时间明显长于乙组患者,差异有统计学意义(t=2.18,P=0.04);甲组患者术中出血量多于乙组患者、住院时间长于乙组患者,但差异无统计学意义(P>0.05).2组患者术后伤椎前缘高度明显大于手术前,Cobb角明显小于手术前,差异均有统计学意义(P<0.05),但2组患者术后7 d椎前缘高度和Cobb角比较差异无统计学意义(P>0.05);甲组患者术后1年伤椎前缘高度明显大于乙组,椎前缘高度矫正丢失率明显低于对照组,差异均有统计学意义(P<0.05);甲组患者术后1年Cobb角和Cobb角矫正丢失率均明显小于乙组,差异均有统计学意义(P<0.05).甲组患者Oswestry功能障碍评分明显小于乙组,差异有统计学意义(t=3.34,P=0.00);甲组患者内固定失败率为4.76%明显低于乙组的28.57%,差异有统计学意义(t=4.29,P=0.04).结论 胸腰椎骨折治疗中伤椎置钉术较跨伤椎置钉的手术时间更长,但患者术后伤椎前缘高度和Cobb角改善均更显著,且患者Oswestry功能障碍评分更低,值得在临床推广应用.%Objective To analyze and compare the influence of trans-traumatic-verterbrae screw fixation and injured vertebrae screw fixation on the clinical efficacy and Oswestry dysfunction score in treatment of thoracolumbar fractures. Methods A total of 42 patients with thoracolumbar fractures who were treated by internal fixation in our hospital from January 2015 to January 2016 were enrolled in the study. According to the mode of screw-setting,21 patients in group A were treated by injured vertebrae screw fixation,however,the other 21 patients in group B were treated by trans-traumatic-verterbrae screw fixation. The patients in both groups were followed up for 1 year. The relative indexes of perioperative period and the scores of the Oswestry dysfunction were observed and compared between the two groups. The height of the anterior margin and the Cobb angle of injured vertebrae before and after operation were also observed and compared between two groups. Results The operative duration (125.43 ± 18.72) in group A was significantly longer than that in group B (113.92 ± 15.28), the difference was statistically significant (t=2.18,P<0.05). The amount of bleeding and the duration of hospitalization in group A were more than those in group B, but the difference was not statistically significant (P>0.05). The height of the anterior margin of injured vertebrae after operation was significantly larger than that before operation in both groups (P <0.05),and the angle of Cobb after operation was significantly smaller than that before operation in both groups (P<0.05). However there were no statistical differences in the height of anterior margin and the angle of Cobb between the two groups at 7 days after operation(P>0.05). The height of the anterior margin of injured vertebrae in group A at 1 years after operation was significantly higher than that in group B,and the correction loss rate of vertebrae anterior margin height in group A was significantly lower than that in group B(P<0.05). The Cobb angle and the correction loss rate of Cobb angle in group A at 1 year after operation were significantly smaller than those in group B(P<0.05). The Oswestry dysfunction scores in group A were significantly lower than those in group B (t =3. 34,P <0. 05). The internal fixation failure rate in group A was significantly lower than that in group B(t=4.29,P<0.05).Conclusion The duration of operation of the injured vertebrae screw fixation is longer than that of the trans-traumatic-verterbrae screw fixation, but the height of the anterior margin of injured vertebrae and the improvement degree of the Cobb angle of the patients receiving injured vertebrae screw fixation are more obvious,and the Oswestry dysfunction scores of patients are lower, therefor, which is worth using widely in clinical practice.
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