目的 比较后路短节段应用与不应用伤椎椎弓根钉的临床疗效,探讨后路短节段结合应用伤椎椎弓根螺钉复位效果的理论依据,为合理选择治疗方案提供依据.方法 胸腰椎单节段骨折患者41例,行后路短节段钉棒系统结合伤椎椎弓根钉内固定(A组)23例,行后路短节段椎弓根钉棒系统内固定(B组)18例.疗效指标,椎体前缘高度压缩率、cobb角、椎管阻塞指数及手术时间、出血量、住院时间.结果 全部患者平均随访20个月,①2组患者围手术期指标,无明显区别(P>0.05).②后凸cobb角比较,A组手术方法在矫正脊柱后凸方面优于B组,差异有统计学意义(P<0.01),且2组术前较术后后凸cobb角差异有统计学意义(P<0.01).③伤椎椎体前缘压缩率的比较,2组术后伤椎椎体前缘压缩率差异有统计学意义(P<0.01),且2组术后较术前差异有统计学意义(P<0.01).④椎管阻塞指数比较,2组术后椎管阻塞指数的比较差异无统计学意义(P>0.05).2组组内术后与术前相比,差异有统计学意义(P<0.05).结论 在传统后路短节段椎弓根钉棒系统的基础上加用伤椎椎弓根钉内固定,与传统术式没有差别.%Objective To compare the clinical efficacy of posterior short - segment combined with pedicle or not, investigate the theoretical basis on reduction effect of posterior short - segment combined with pedicle screw and supply proof for selecting treatment protocol reasonably. Methods Forty - one cases with thoracolumbar fracture were divided into two groups: group A was made up of 23 cases with posterior short - segment pedicle spinal internal fixation combined with pedicle screw, group B was made up of 18 cases with posterior short - segment pedicle spinal internal fixation. The indexes including percentage of anterior body height compression, local kyphosis Cobb angle, spinal canal obstructive index, operation time, blood loss and hospital stay were investigated. Results All patients had been followed up for 20 months. ①There was no significant difference between the patients in both groups concerning blood loss, operation time, the length of incision, hospital stay, which indicated that as the aspect of perioperative period index, there was no statistical significance on surgery method. ②There was statistical significance in local kyphosis Cobb angle between the two groups postoperatively ( P < 0. 01 ), and there were significant differences in both groups between preoperative and postoperative( P < 0. 01 ). ③There was no significant difference in percentage of anterior body height compression between the twogroups preoperatively, but there was statistical significance between the two groups postoperatively ( P < 0. 01 ), there were significant difference in both groups between preoperative and postoperative ( P < 0. 01 ). (4) There was no significant difference in spinal canal obstructive index between the two groups preoperatively, there was no statistical significance between the two groups postoperatively, there were significant difference in both groups between preoperative and postoperative( P < 0. 01 ). Conclusion Posterior short - segment combined with pedicle screw can repair the appearance of fractured vertebra better,in favour of modificating kyphosis deformity and maintaining the recuperative vertebal sequence. Comparing with traditional surgery method, there was no difference in making the bone block intruded into spinal canal restore, surgery time, the length of incision and hospital stay.
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