短节段固定联合伤椎植骨置钉与传统后路短节段固定治疗胸腰段骨折疗效对比

摘要

Objective To investigate the clinical effect of unilateral pedicle screw fixation combined with bone graft and posterior short segment fixation in the treatment of thoracolumbar fractures .Methods Eighty cases of thoracolumbar burst fracture in our hospital from June 2010 to June 2015 were selected and divided into obser‐vation group (40 cases) and control group (40 cases) according to the different treatment methods .The observa‐tion group was treated with unilateral pedicle screw fixation combined with bone graft ,and the control group was treated with posterior short segment fixation .We observed two groups of patients with vertebral height ratio , Cobb′s angle ,vertebral wedge angle ,VAS score and ODI score before surgery and 6 months after surgery .Results Six months after surgery ,anterior vertebral height of patients in two groups increased significantly ( P <0.05) ,Cobb′s angle of the spine and injured vertebral wedge angle change are significantly reduced ( P<0.05) , and the observation group improved more significantly than the control group ( P <0.05);Compared with those before operation ,VAS and ODI scores in two groups were significantly lower ( P<0.05) ,and VAS score in ob‐servation group decreased more significantly ( P<0.05) than the control group ,but there is no significant differ‐ence for the ODI score between observation group and control group( P >0.05);There was no significant differ‐ence in observation group (82% ) ,and control group (80% ) ,and the difference was not statistically significant(P>0.05) .Conclusion Unilateral pedicle screw fixation combined with bone graft in the treatment of thoracolum‐bar fracture can better restore vertebral height and physiological curvature of the spine and spinal stability .It is worth clinical application .%目的：探讨短节段固定联合伤椎植骨置钉与传统后路短节段固定治疗胸腰段骨折的临床疗效。方法回顾性分析陕西省洛川县医院2010年6月至2015年6月收治的80例胸腰椎爆裂性骨折患者的临床资料，分为观察组和对照组各40例。观察组患者给予短节段固定联合伤椎植骨置钉治疗，对照组给予单纯后路短节段固定治疗。记录2组患者的手术时间、住院时间、带支具离床时间、术后引流量及术后24 h肌酸激酶水平，观察比较术前、术后6个月2组患者伤椎椎体高度比、脊柱Cobb角、伤椎椎体楔形变角变化，视觉模拟评分法（VAS）进行疼痛评分，Oswestry功能障碍指数（ODI）评分，并根据ODI计算术后神经功能改善率。结果观察组住院时间、带支具离床时间、术后引流量及术后24 h肌酸激酶水平均明显低于对照组（ P ＜0.05）。术后6个月，2组患者伤椎前缘高度比较术前显著增加（ P ＜0.05），脊柱Cobb角、伤椎椎体楔形变角较术前显著降低（ P＜0.05），且观察组较对照组改善更明显（ P ＜0.05）；2组患者 VAS评分及ODI评分较术前均显著降低（ P ＜0.05），且观察组VAS评分较对照组降低更明显（ P ＜0.05），但观察组ODI评分与对照组比较差异无统计学意义（ P ＞0.05）。观察组神经功能改善率为82％，与对照组的80％比较差异无统计学意义（ P ＞0.05）。结论短节段固定联合伤椎植骨置钉治疗胸腰段骨折能更好地恢复伤椎高度、脊柱生理曲度以及脊柱稳定性，且创伤小、恢复快，值得临床推广应用。