椎间盘完整性对胸腰椎爆裂性骨折手术疗效的影响

摘要

目的 探讨椎间盘破损与否,对胸腰椎爆裂性骨折患者手术疗效的影响.方法 回顾性分析2010-10-2013-10收治的90例胸腰椎爆裂骨折患者,依据其椎间盘完整与否,分为椎间盘完整组(A组,n=41)与破损组(B组,n=49);同时依据各组内固定术中是否采用椎间或后外侧融合,分为未融合组(A1和B1组)与融合组(A2和B2组),其中A1组30例,A2组11例;B1组15例,B2组34例.对各亚组的手术前后相关指标进行对比.结果 90例患者均顺利完成手术,术后8例患者发生并发症,包括切口感染2例,肺部感染1例,脑脊液漏2例,切口脂肪液化1例,1例术后16个月螺钉断裂,1例术后22个月出现断棒,均予以相关处理.所有患者均获31-45个月随访,结果显示:(1)术前存在椎间盘破损者,无论是否采用融合手术,其内固定后的Cobb角、椎体前缘高度压缩率均有明显丢失现象(B1 VS A1,以及B2 VS A2,均为P<0.05).(2)椎间盘破损者采用融合术后,可明显改善其矫正角度与伤椎高度的丢失情况(B2 VS B1,P<0.05).(3)在功能障碍指数(ODI)方面,未予融合术式的椎间盘破损者,其功能障碍程度明显差于另外三组(B1组VS其他三组,P<0.05).结论 椎间盘完整与否对胸腰椎爆裂性骨折内固定术后的疗效有明显影响:存在椎间盘破损者,后期可能出现后凸畸形加重以及伤椎高度丢失,故应酌情考虑予以融合手术,降低此方面影响.%Objective To explore the effect of the intervertebral disc damage or not, on the efficacy of surgical treatment of thoracolumbar burst fracture patients. Methods a retrospective analysis of 90 cases of thoracolumbar-2013 October 2010 October were burst fracture patients, on the basis of the disc complete or not, divided into the intervertebral disc intact group (A group, n=41) and injury group (group B, n=49); at the same time on the basis of intervertebral or by groups in the internal fixation with posterolateral fusion divided into non fusion subgroups (A1 and B1 group (A2) and fusion sub group and B2 group), including 30 cases of A1 group, A2 group of 11 cases; 15 cases in B1 group, B2 group of 34 cases. The correlation indexes were compared before and after operation in each subgroup. Results 90 patients were successfully completed surgery, 8 cases of patients with postoperative complications, including incision infection in 2 cases, 1 cases of pulmonary infection, 2 cases of cerebrospinal fluid leakage, incision fat liquefaction in 1 cases, 1 cases of postoperative 16 months screw fracture, 1 cases occurred 22 months after broken bar, are to be related processing. All patients were followed up for 31-45 months. The results showed:(1) the presence of preoperative intervertebral disc damage, regardless of whether the fusion surgery, the fixation of Cobb angle, anterior vertebral height loss rate markedly (B1 VS A1, B2 VS and A2, both P<0.05). (2) B2 VS B1, P<0.05 (B2) can significantly improve the correction angle and the height of the injured vertebra after fusion. (3) the disability index (ODI), intervertebral disc does not damage fusion, the degree of impairment was worse than the other three groups (B1 group VS the other three groups,P<0.05). Conclusion the intervertebral disc completeness of thoracolumbar burst fractures after internal fixation have significant influence on the intervertebral disc damage, the latter may be kyphotic deformity and loss of vertebral height, so it should be taken into consideration to reduce the effect of fusion surgery.