胸腰椎骨折后路非融合椎弓根钉内固定疗效及术后椎间盘退变的评价

摘要

目的 评价胸腰椎骨折后路非融合椎弓根钉内固定临床疗效及术后骨折椎上、下位椎间盘退变情况.方法 福建医科大学附属龙岩市第一医院2015年6月-2016年6月采用后路融合椎弓根钉内固定治疗胸腰椎骨折37例(融合组)及非融合椎弓根钉内固定治疗胸腰椎骨折24例(非融合组),男性38例,女性23例;年龄33~65岁,平均49.92岁.所有病例均满足:(1)美国脊柱脊髓损伤研究小组制定的胸腰段脊髓损伤程度评分系统(TLICS)评分均≥4分,载荷分享评分≤6分;(2)按脊柱骨折AO分类均属于A型;(3)单节段骨折,CT示椎管内骨块完整,无碎裂翻转;(4)美国脊柱损伤协会(ASIA)神经功能分级为E级.比较两组手术时间、术中出血量、术后引流量.术后1年,自身未受伤椎间盘为参照标准,Pearce分级评定非融合组邻近节段和骨折椎上、下位椎间盘退变情况.结果 非融合组能减少手术时间、术中出血量、术后切口引流量,也能很好地矫正椎体的高度和角度,在丢失量方面和融合组没有差别(P>0.05);非融合组术后1年取出内固定,有3例骨折椎上位或下位椎间盘发生不同程度的退变,与术前相比,差异无统计学意义(P>0.05).骨折椎上位或下位椎间盘纤维环新增高信号区2例,均伴有不同程度的腰痛,1例取出内固定后椎间盘纤维环高信号区消失;融合组的融合率为67.57%(25/37).结论 非融合内固定术不但能减少手术时间、术中出血量、术后切口引流量,而且可以很好地矫正骨折椎的高度和角度,术后1年邻近节段及骨折椎上、下位椎间盘未发生显著退变.%Objective To evaluate the efficacy and disc degeneratoin of the pedicle screw fixation using nonfusion method in the treatment of thoracolumbar fracture.Methods Thirty-seven patients were treated by pos-terior pedicle screw internal fixation with fusion method(fusion group)and twenty-four patients were treated with nonfusion method(nonfusion group)from Jun.2015 to Jun.2016 in Longyan First Hospital Affiliated to Fujian Medical University.There were 38 males and 23 females,aged from 33 to 65(mean,49.92).All cases met the fol-lowing conditions:TLICS≥4,type A accrording to AO classification,single segment fracture and grade E neurologi-cal function according to ASIA.The therapeutic effect between the two groups was compared and the adjacent dis degenerative changes in the groups at 1 year after surgery were assessed using nonfusion method according to Pearce classification.Results The nonfusion treatment could shorten the surgical time as well as reduce the amount of surgical blood and incision draining loss; it could also effectively recover the height of injured vertebral body and rectify the posterior salient.There was no significant difference between two groups in the loss of height and posterior salient of injured vertebral body after restoration(P>0.05).In the nonfusion group,after removal of the internal fixation at 1 year after operation,there were 3 cases of intervertebral discs with different degrees of degeneration,but no difference with the preoperative ones(P>0.05).Two new high intensity zones were discovered in the annulus fi-brosus,both of whom suffered backache at varying degrees.One high intensity zone disappeared after removing fixa-tion.The fusion rate of the fusion group was 67.57%(25/37).Conclusion Nonfusion treatment could not only shorten the surgical time and reduce the amount of surgical blood and incision draining loss,but also could effectively recover the height of injured vertebral body and rectify the posterior salient.One year after operation,the adjacent in-tervertebral discs did not degenerate significantly in comparison with the preoperative ones.There was no significant degeneration in the adjacent intervertebral discs at 1 year after surgery.