后外侧融合与否对无脊髓损伤的不稳定胸腰椎骨折的疗效影响

摘要

Objective To observe the effect of posterolateral fusion or not on unstable thoracolumbar fractures without neurologic deficit.Methods 60 patients with single segment unstable thoracolumbar fractures without neurological deficit were classified into two groups according to therapeutic methods.Group A consisted of 30 patients who were treated by posterior pedicle screw fixation via posterolateral fusion with iliac bone or allograft bone;Group B consisted of the other 30 patients who were treated by posterior pedicle screw fixation without posterolateral fusion.The Cobb angle,vertebral kyphotic angle,height of vertebral anterior edge and height of vertebral posterior edge were measured on the preoperative,postoperative and last follow-up lateral X-ray film,the measuring results were compared.Clini-cal outcomes were evaluated by Japanese Orthopedic Association Scores(JOA)and Visual Analogue Score(VAS). Results Patients of two groups were followed up during 12~60 months.The Cobb angle,vertebral kyphotic angle, height of vertebral anterior edge and height of vertebral posterior edge including their corrective degree and loss degree were compared in preoperatively,postoperatively and the last follow-up between two groups,there were no significant differences (P>0.05 ).There were also no significant differences on JOA scores and VAS scores between two groups (P>0.05 ).Conclusions Posterolateral fusion or not don′t make big differences in treating thoracolumbar fractures without neurological deficit by posterior pedicle screw instrumentation.%目的：观察后外侧融合对后路椎弓根钉内固定治疗无脊髓损伤的不稳定胸腰椎骨折的疗效影响。方法60例均为单一节段无脊髓损伤的不稳定胸腰椎骨折患者，按治疗方法分为2组：A组30例，行后路复位椎弓根钉内固定术，并取自体髂骨或同种异体骨行后外侧融合；B组30例，仅行后路复位椎弓根钉内固定术，未做植骨融合。术前、术后和末次随访时在X线侧位片上测量Cobb角、伤椎后凸角、伤椎前缘高度、伤椎后缘高度，比较各项指标的结果。临床疗效评价采用腰椎JOA评分法和视觉模拟评分法（VAS ）进行评定。结果两组患者均获得随访，时间12～60个月。术前、术后及末次随访时两组间Cobb角、伤椎后凸角、伤椎前缘高度、伤椎后缘高度各项指标及其矫正度和丢失度比较差异均无统计学意义（P＞0.05）；JOA评分、VAS评分两组间比较差异亦无统计学意义（P＞0.05）。结论后路复位椎弓根钉内固定术治疗无脊髓损伤的不稳定胸腰椎骨折，后外侧融合与否对临床疗效无明显影响。