后路经伤椎内固定结合椎体内植骨治疗不稳定胸腰椎骨折的临床研究

摘要

Objective To explore the clinical effect of treating thoracolumbar fracture with in-ternal fixation and bone graft through pedicles of the fractured vertebra retrospectively. Methods 27 cases with thoracolumbar fractures were treated with internal fixation and bone graft through pedicles of the fractured vertebra (group A). another 27 cases with thoracolumbar fractures were treated with internal fixation of the fractured vertebra and the vertebra above and below the frac-tured vertebra (group B). The clinical effect was analyzed by Frankel assessment and CT、X-ray appearance. Results All patients were follow-up for an average of 15 months (range,12 months to 24 moths). There were significant deference between the two groups about the the Cobb angle and the height of fractured vertebra after internal fixations removed. There were no significant deference between postoperative and after internal fixations removed about the the Cobb angle and the height of fractured vertebra in group A. But there were significant differences in group B. The nerve function of all patients acquired an improvement compared with pre-operation,there were no significant deference between the two groups. Conclusion Internal fixation and bone graft through pedicle of fractured vertebra is reliable for thoracolumbar fractures.%目的：观察后路经伤椎内固定结合椎体内植骨手术方式治疗不稳定性胸腰椎骨折的中远期临床疗效。方法2008-02－2012-02，27例不稳定性胸腰椎骨折患者采用了经伤椎固定结合椎体内植骨手术方式进行治疗（A组），随机取同期仅行伤椎及相邻上下椎固定治疗的27例不稳定胸腰椎骨折患者（B组），进行对照观察。观察术前、术后及拆除内固定后伤椎前缘压缩率和后凸角（Cobb’s角）及神经功能恢复情况。结果 A组与B组比较，内固定拆除后椎体高度恢复率及后凸角组间差异皆有统计学差异（P<0.05）；A组内固定拆除后与术后当时相比无统计学差异（P>0.05）；B组内固定拆除后与术后当时相比有统计学差异（P<0.05）。伤椎固定椎体内植骨组27例患者及对照组27例患者术后神经功能损伤均有一级以上神经功能恢复，神经功能损伤恢复组间比较差异无显著性（P>0.05）。结论后路经伤椎内固定结合椎体内植骨术治疗不稳定性胸腰椎骨折能获得较好的中远期椎体复位效果。