【摘要】 目的观察后路经伤椎短节段椎弓根内固定术治疗胸腰椎压缩或爆裂骨折的效果及预后。方法选取2018年10月—2020年6月收治的单节段胸腰椎压缩或爆裂骨折93例,据手术方式的不同分为观察组48例和对照组45例。观察组给予后路经伤椎短节段椎弓根内固定术,对照组给予后路经伤椎跨节段椎弓根内固定术。比较两组围术期指标,术前及术后2周、3个月、6个月时视觉模拟评分法(VAS)评分、Oswestry功能障碍指数(ODI)评分,术后3、6个月伤椎前缘高度丢失率,以及术后内固定效果。结果观察组手术时间长于对照组(P<0.05),但两组术中出血量和住院时间比较差异无统计学意义(P>0.05)。两组术后2周、3及6个月的VAS评分、ODI评分均较术前降低,且术后3和6个月低于术后2周,术后6个月低于术后3个月(P<0.01)。术后2周、3及6个月,观察组ODI评分低于对照组(P<0.01),但两组VAS评分比较差异无统计学意义(P>0.05)。术后3、6个月,观察组伤椎前缘高度丢失率均低于对照组(P<0.01)。术后随访6个月,观察组内固定失败发生率低于对照组(P<0.05)。结论后路经伤椎短节段椎弓根内固定术在改善胸腰椎压缩或爆裂骨折患者伤椎功能、维持术后伤椎高度及降低内固定失败率方面优势明显。更多还原

【Abstract】 Objective To observe the effectiveness and prognosis of posterior short segment pedicle screw fixation through the injured vertebra in treatment of patients with thoracolumbar compression or burst fractures. Methods A total of 93 patients with single-segment thoracolumbar compression or burst fractures admitted between October 2018 and June 2020 were selected and divided into observation group(n=48) and control group(n=45) according to different surgical methods. Observation group was given posterior short segment pedicle screw fixation through the injured vertebra, while control group was given posterior cross segment pedicle screw fixation through the injured vertebra. Values of perioperative indexes, visual analogue scale(VAS) scores and Oswestry dysfunction index(ODI) scores before and after operation for 2 weeks, 3 months and 6 months, loss rate of anterior edge height of the injured vertebrae and the effectiveness of internal fixation after operation were compared between two groups. Results Operative duration in observation group was significantly longer than that in control group(P<0.05), but there were no significant differences in intraoperative volume of blood loss and length of hospital stay between two groups(P>0.05). In two groups, VAS and ODI scores after operation for 2 weeks, 3 months and 6 months were significantly lower than those before operation, and the scores after operation for 3 and 6 months were significantly lower than those after operation for 2 weeks, and the scores after operation for 6 months were significantly lower than those after operation for 3 months(P<0.01). ODI scores after operation for 2 weeks, 3 months and 6 months in observation group were significantly lower than those in control group(P<0.01), but there were no significant differences in VAS scores between two groups(P>0.05). The anterior height loss rates of injured vertebra after operation for 3 and 6 months in observation group were significantly lower than those in control group(P<0.01). After 6 months of follow-up, incidence rate of internal fixation failure in observation group was significantly lower than that in control group(P<0.05). Conclusion Posterior short segment pedicle screw fixation through the injured vertebra has obvious advantages in improving the function of injured vertebra, maintaining the height of injured vertebra and reducing the failure rate of internal fixation in treatment of patients with thoracolumbar compression or burst fractures.更多还原