单侧或双侧伤椎置钉治疗胸腰段爆裂骨折的比较

摘要

目的 研究单侧伤椎置钉联合短节段椎弓根螺钉内固定在治疗胸腰段单椎体爆裂型骨折中的应用价值.方法 收集2011年9月至2015年7月我科胸腰段单椎体爆裂型骨折患者的诊治资料,将单侧伤椎置钉组41例(组Ⅰ)、双侧伤椎置钉组34例(组Ⅱ)的术中参考指标(失血量、手术时长)、术后参考指标(椎体前缘高度比、后凸角)进行比较.结果 共置入螺钉409枚,随访12~16个月,平均15.6个月.术后未出现神经功能损害加重的情况,术前有神经功能不完全损害的11例患者均获得完全恢复.骨折骨性愈合时间12~20周,平均14.1周.无内固定断裂、松动和退出,无后凸角度丢失大于等于10°的病例.组Ⅰ和组Ⅱ的手术时长、失血量方面差异无统计学意义.组Ⅰ、组Ⅱ的术后椎体前缘高度比、椎体后凸角与术前对比差异具有统计学意义(P<0.05);术后1周和术后1年对比差异无统计学意义(P>0.05);组Ⅰ、组Ⅱ在术后1周、术后1年相互对比差异无统计学意义(P>0.05).结论 伤椎置钉短节段椎弓根螺钉内固定治疗胸腰段单椎体爆裂型骨折,可有效矫正椎体压缩、后凸畸形,有效防止伤椎复位再丢失,减少内植物并发症.单侧和双侧伤椎置钉可达到同样的效果,临床可行性较好.%Objective To explore the clinical value of unilateral injured vertebra fixation combined with short-segment fixation in the treatment of thoracolumbar burst fractures.Methods We compared blood loss,operative time,kyphosis angle and vertebral height ratio of the unilateral injured vertebra fixation group Ⅰ(41 cases) with bilateral injured vertebra fixation group Ⅱ(34 cases).All these cases were admitted in our hospital from September 2011 to July 2015.Results All of the operations were successfully completed,409 screws were inserted.The average healing time of the fracture was 15.6 months(from 12 to 24 months).There were no cases whose neurological impairment got worse.The 11 cases preoperative with incomplete neurological impairment got full recovery after operation.No breakage、loosening and exit of internal fixation occurred during the follow-up.There were no cases whose kyphosis lost more than 10 degrees.The operative time,blood loss of the two groups had no statistically difference(P>0.05).Their postoperative vertebral height ratio and kyphosis angle of the two groups compared with preoperative were statistically significant(P<0.05).1 year follow-up had no statistically difference compared with 1 week follow-up(P>0.05).1 week follow-up of their vertebral height ratio and kyphosis angle had no statistically difference compared with each other (P>0.05).Conclusion Injured vertebra fixation combined with short-segment fixation for thoracolumbar burst fractures can improve the kyphosis,rectify with vertebral compression,avoid the lost of reduction and reduce the complication of implant.Unilateral or bilateral injured vertebra fixation can achieve the same effects.