【摘要】 目的比较传统后路椎弓根螺钉固定与附加经伤椎椎体内植骨及椎弓根螺钉固定治疗胸腰椎骨折的临床疗效。方法自2006年2月-2009年8月,将24例新鲜胸腰段脊椎Gertzbein A3型骨折患者随机分成A、B两组。分别采用传统椎弓根螺钉内固定、减压复位、椎板植骨融合术(A组)及采用附加经伤椎固定椎体内植骨、减压复位、椎板植骨融合术(B组)。分别于术后3,6,9,12个月对两组患者临床及影像学资料进行随访。比较测量手术前后Cobb’s角、椎体前缘高度和椎管占位率。结果两组安全完成手术,切口Ⅰ期愈合。随访14～42个月,平均18个月。术后A、B组Cobb’s角分别矫正至4.2°和3.8°;椎体前缘高度分别恢复至85.4%和86.8%;平均椎管占位率分别为4.8%和4.4%,与术前比较差异有统计学意义(P<0.05)。末次随访时A组Cobb’s角为5.5°,B组为3.9°;椎体前缘高度A组为恢复至73.3%,B组为恢复至86.1%;平均椎管占位率A组为5.1%,B组为4.4%。末次随访时A组Cobb’s角、椎体前缘高度和椎管占位率与B组比较差异均有统计学意义(P<0.05)。A组有2例在末次随访时后凸角丢失>10°,1例内固定失败。结论经伤椎置钉能有效地恢复椎体前缘高度,伤椎椎体内植骨可有效维持复位,减少后凸畸形矫正丢失及内固定失败。更多还原

【Abstract】 Objective To compare the clinical outcome of conventional posterior fixation with via affected vertebra fixation in addition bone graft for thoracolumbar burst fractures(Gertzbein A3).Methods From February 2006 to August 2009,according to random classification,24 patients were divided into group A(control group) and group B(trail group).Group A underwent conventional posterior short-segment fixation,and group B use the same way as group A but plus via affected vertebra fixation and bone graft.The postoperative Cobb’s angle,anterior vertebral height and canal encroachment rate were fallowed at 3,6,9 and 12 month respectively.Results All cases were followed up for 14 to 42 months(mean 18 months).The mean postoperative Cobb’s angle were corrected to 4.2 for group A and 3.8 for group B;Anterior height of vertebral body recovered to 85.4% for group A and 86.8% for group B;The mean canal encroachment rate was 4.8% for group A and 4.4% for group B.The Cobb’s angle,anterior height of the fractured vertebra body and canal encroachment rate were all significantly different between pre-operation and post-operation in each group(P<0.05).At final follow-up,Cobb’s angle was 5.5 for group A and 3.9 for group B;Anterior vertebral height was 73.3% for group A and 86.1% for group B;Canal encroachment rate was 5.1% for group A and 4.4% for group B,there were significant difference in two group at final follow-up(P<0.05).More than 10 correction loss occurred in two patients in group A,and the implant failure was found in one case,while there was no implant failure in group B.Conclusion The pedicle screw fixation and bone graft through the pedicle of fractured vertebra can maintain the reduction,decrease the rate of correction loss and internal fixation failure.更多还原