【摘要】 目的探讨经伤椎椎弓根复位固定治疗胸、腰椎骨折的可行性及其临床疗效。方法将47例单椎体胸、腰椎骨折患者分组:单纯行跨伤椎的4钉固定术(4钉组)25例,经伤椎椎弓根固定的6钉固定术(6钉组)22例。所有患者随访16～43个月,平均随访(26.63±3.54)月。比较两组的术中出血量、手术时间、术后伤口引流量、术后卧床时间等围手术期指标及伤椎前后缘高度比、内固定失败率、腰背痛评分改善率及神经功能恢复情况。结果两组围手术期相关指标中,术后卧床时间及术后伤口引流量比较,差异均有统计学意义(t分别=5.69、3.56,P均<0.05);6钉组的伤椎前、后缘高度比,术后较术前均有明显改善,且6钉组的伤椎前缘、后缘高度比术后及随访期间均优于4钉组,差异均有统计学意义(t分别=2.98、3.24、5.47、3.68,P均<0.05)。4钉组固定术后过度撑开致术后后凸加重发生率为16.00%,螺钉松动率为12.00%,6钉组无上述情况。6钉组术后1周和术后6月随访腰背痛评分,平均改善率均高于4钉组,差异均有统计学意义(t分别=3.37、3.56,P均<0.05)。但两组术后神经功能恢复情况比较,差异无统计学意义(t=1.56,P>0.05)。结论经伤椎椎弓根置钉能更直接牢固的复位和固定骨折,改善固定强度和应力分布,较传统跨伤椎固定能更好维持矫正效果。更多还原

【Abstract】 Objective To study the feasibility and clinical therapeutic effect of reduction and fixation of thoracolumbar fractures with screws through the pedicle of fractured vertebral arch.Methods Clinical data about 47 single level thoracolumbar fracture patients were retrospectively analyzed.The patients were divided into 4-screw fixation group(n = 25) and 6-screw fixation group(n=22).The patients were followed up for 16 to 43 months(mean 26.63±3.54 months).The perioperative parameters like incision size,intraoperative blood loss,postoperative drainage,postoperative bed time,and the anterior posterior margin height of fractured vertebra,JOA improvements and recovery of nerve function,internal fixation failure were compared between the two groups.Results The differences of postoperative drainage and bed time were significant between the two groups(t=5.69,3.56,P<0.05).Compared with before operation,the anterior and posterior margin height of fractured vertebra were more significantly improved after operation(t=2.98,3.24,P<0.05),and the 6-screw fixation group’s improvements were more significant than the 4-screw fixation group’s(t=5.47,3.68,P<0.05).Compared with the 4-screw fixation group,the 6-screw fixation group’s JOA improvement was significant(t=3.37,3.56,P<0.05),and the recovery of nerve function were not significant(t =1.56,P >0.05).The incidence of exacerbated postoperative posterior prominence was 8% in 4-screw fixation group with a crew exit rate of 4%.However,no such things occurred in 6-screw fixation group.Conclusions Thoracolumbar fractures with screws through the pedicle of fractured vertebral arch can fix and direct reduction on fractured vertebrae,improve stabilization and disperse stress.It is a safety and effective procedure for the therapy of thoracolumbar fractures.更多还原