经伤椎置钉与跨伤椎短节段内固定治疗胸腰椎骨折的临床疗效对比

摘要

目的比较经伤椎置钉与跨伤椎短节段内固定治疗胸腰椎骨折的临床疗效。方法对2010年7月至2014年1月我院收治的45例胸腰椎单节段骨折患者的临床资料进行回顾性分析，其中采用经伤椎椎弓根内固定的25例患者纳入经伤椎组，采用跨伤椎短节段内固定的20例患者纳入短节段组。比较两组患者术后1周和术后12个月的矢状面Cobb角、伤椎前缘高度比、椎管占位率、腰部疼痛视觉模拟量表（visual analogue scale, VAS）评分、内固定失败情况等。结果本组患者随访（14.7±2.4）个月。术后1周和术后12个月，经伤椎组的Cobb角分别为4.12°±1.51°、4.16°±5.73°，椎管占位率为10.68%±1.73%、5.88%±1.09%，均小于短节段组，但椎体高度比大于短节段组，差异均有统计学意义（均P<0.05）；术后12个月经伤椎组的VAS评分为（1.62±0.73）分，短节段组为（2.18±0.94）分，两组比较差异具有统计学意义（t=2.740，P=0.019）；两组的内固定失败率比较，差异具有统计学意义（χ2=4.065，P=0.044）。结论经伤椎内固定治疗胸腰椎骨折，能提高骨折复位效果和降低伤椎前柱的高度丢失，有利于椎管重建，是治疗胸腰椎骨折的有效方法。%Objective To compare the clinical efficacy of pedicle screw fixation through or across in⁃jured vertebrae in treatment of thoracolumbar fracture. Methods The clinical data of 45 patients with thoraco⁃lumbar fractures who were treated by internal fixation through (25 cases, T group) or across (20 cases, A group) injured vertebrae from July 2010 to January 2014 were retrospectively analyzed. The Cobb’s angle, the anterior height of vertebrae, spinal canal area, visual analogue scale (VAS) scores and the failure rate of internal fixation were compared at 1st week and 12th month post⁃operation. Results All the patients were followed up for (14.7 ± 2.4) months. The Cobb’s angle in T group at 1st week and 12th month post⁃operation was 4.12° ± 1.51° and 4.16°±5.73°, and the spinal canal area was 10.68%±1.73%and 5.88%±1.09%, which was significantly re⁃duced as compared with A group, and the anterior height of vertebrae was greater in T group than in A group sta⁃tistically (all P<0.05). The VAS score in T group was 1.62±0.73 at 12th month post⁃operation, and 2.18±0.94 in A group (t=2.740, P=0.019). There was significant difference between two groups in the internal fixation failure rate (χ2=4.065, P=0.044). Conclusion The internal fixation through the injured vertebrae for thoracolumbar fracture could improve the effect of fracture reduction, reduce the height loss of the injured anterior vertebral column, and help the reconstruction of spinal canal, which was an effective therapy for thoracolumbar fracture .