后外侧植骨融合与非融合在后路短节段固定治疗胸腰段骨折中的疗效比较

摘要

目的：对比分析后外侧植骨融合与非融合在后路短节段固定治疗胸腰段骨折中的临床效果。方法对2011年9月至2012年9月收治的65例胸腰段骨折患者采用后路短节段固定治疗，比较复位内固定术后1年、取出内固定术后3个月植骨融合组（40例）与非融合组（25例）患者脊柱后凸Cobb角的丢失度数、伤椎前缘高度丢失百分比及并发症情况，以视觉模拟评分（VAS）法评价患者腰背痛程度。65例患者术后均获随访，随访时间14~26个月，平均18个月。结果65例患者腰背痛均有不同程度减轻，每例患者2次手术前后VAS评分比较，差异无统计学意义（P>0.05）；复位内固定术后1年、取出内固定物术后3个月，两组患者脊柱后凸Cobb角及伤椎前缘高度百分比比较均有不同程度丢失，且非融合组丢失较多，两组比较，差异有统计学意义（P<0.05）。植骨融合组发生螺钉退出2例，无一例发生断钉、断棒；非植骨融合组螺钉退出3例，内固定断裂2例，两组比较，差异有统计学意义（P=0.097）。结论后路短节段椎弓根内固定结合后外侧植骨融合是手术治疗胸腰段骨折的理想方法之一。%Objective To compare the clinical outcomes of posterolateral fusion and non-posterolateral fusion combined with posterior short segment internal fixation in the treatment of thoracolumbar fractures. Methods A total of 65 patients with thoracolumbar fracture,who were received in the hospital from September 2011 to September 2012,were all treated with posterior short segment internal fixation. The loss degree of kyphos Cobb′s angle,height of the injured vertebra and complications were com-pared in fusion group(n=40) and non-fusion group(n=25) 1 year after the operation and 3 months after removal of the internal fix ation. The visual analogue scale (VAS) was used to evaluate the degree of back pain. All the 65 patients were followed up for 14-26 months with the average of 18 months. Results The lumbago and backache of all the 65 patients got alleviated in different degrees , and the comparison of VAS value between the two groups had no statistically significant difference (P>0.05). The kyphos Cobb′s angle and height of the injured vertebra 1 year after reduction and internal fisation and 3 months after removal of the internal fixa-tion in two groups were lost differently,the non-fusion group lost more,and the difference between the two groups was statistically significant(P<0.05). 2 pedicle screws exited in fusion group without broken fixation;while 3 pedicle screws exited in non-fusion group with 2 broken fixations and the difference between the two groups had statistical significance (P=0.097). Conclusion Poste-rior short segmental pedicle internal fixation combined with posterolateral bone graft fusion is one of ideal methods for the treat-ment of thoracolumbar fracture.