【摘要】 目的对经伤椎椎弓根钉置入与跨节段置钉治疗胸腰椎椎体骨折脱位的疗效进行对比分析,为临床治疗提供理论依据,可根据患者具体情况采取合适的治疗方法。方法 2013年8月~2015年12月,我院共收入胸腰椎椎体骨折脱位患者62例,随机分为两组,记为Ⅰ、Ⅱ组,每组各31例。Ⅰ组患者采用经伤椎椎弓根钉置入治疗,Ⅱ组患者采用跨节段置钉治疗,比较复位成功率,术后可进行影像学检查,测量伤椎椎体前缘高度的比值和Cobbs角,比较随访期间内固定失效、丢失情况。结果治疗后,两组患者伤椎椎体前缘高度比值均升高,第Ⅰ组升高的程度较第Ⅱ组大,二者差异有统计学意义(P<0.05)。经积极治疗后,第Ⅰ组患者Cobbs角普遍较第Ⅱ组患者小,二者差异具有统计学意义(P<0.05)。由此可见,经伤椎椎弓根钉置入治疗胸腰椎骨折脱位疗效更显著。经术后随访观察发现,第Ⅰ组31例患者中固定无失效,第Ⅱ组患者中有4例失效,出现椎弓根钉松动、断裂等情况,二者差异具有统计学意义(P<0.05)。第Ⅰ组患者中有1例患者出现内固定丢失的情况,第Ⅱ组患者中有7例内固定丢失,差异有统计学意义(P<0.05)。结论对胸腰椎椎体骨折脱位患者行经伤椎椎弓根钉置入治疗的疗效较行跨节段置钉治疗的疗效好,且持续时间长,推荐临床广泛应用。更多还原

【Abstract】 Objective To compare and analyze the curative effect of transpedicular screw placement and intersegmental screw placement in the treatment of thoracolumbar vertebral body fracture and dislocation,which provides a theoretical basis for clinical treatment,and can take appropriate treatment methods according to the specific situation of the patients. Methods From August 2013 to December 2015,62 patients with thoracolumbar vertebral body fracture and dislocation in our hospital were randomly divided into two groups:group Ⅰ and group Ⅱ,with 31 cases in each group.The patients in group Ⅰ were treated with pedicle screw implantation and group Ⅱ were treated with transpedicular nail placement.The successful rate of reduction was compared and the imaging examination was performed after operation.The ratio of anterior height of injured vertebrae and Cobbs angle were measured to compare the failure and loss of internal fixation during follow-up. Results After treatment,the ratio of anterior height of injured vertebrae was increased in both groups,and the degree of elevation in group Ⅰ was greater than that in group Ⅱ,and the difference was statistically significant(P < 0.05). After active treatment,the Cobbs angle of group Ⅰ was generally smaller than that of group Ⅱ,and the difference was statistically significant(P < 0.05).Therefore,transpedicular screw placement was more effective in the treatment of thoracolumbar fracture and dislocation.The results of follow-up showed that there was no failure of fixation in group Ⅰ(31 cases) and 4 cases(group Ⅱ) with loosening and fracture of pedicle nail.The difference was statistically significant(P < 0.05).There was a loss of internal fixation in one patient in group Ⅰ and seven in group Ⅱ(P < 0.05). Conclusion The treatment of thoracolumbar vertebral fracture and dislocation with vertebral pedicle screw placement is better than that of the treatment of the cross section of the nail,and the duration of the treatment is long.更多还原