后路短節(jié)段固定融合與非融合治療胸腰椎爆裂骨折的比較研究

發(fā)布時(shí)間：2018-10-20 20:48

【摘要】：目的比較后路短節(jié)段椎弓根螺釘固定融合與非融合治療胸腰椎爆裂骨折的療效。方法回顧分析2012年2月-2014年2月采用后路短節(jié)段椎弓根螺釘固定治療,并符合納入標(biāo)準(zhǔn)的57例單節(jié)段胸腰椎爆裂骨折患者臨床資料,其中27例術(shù)中行融合(融合組),30例未行融合(非融合組)。兩組患者性別、年齡、致傷原因、受傷至入院時(shí)間、骨折節(jié)段及分型、神經(jīng)功能美國(guó)脊髓損傷協(xié)會(huì)(ASIA)分級(jí)等一般資料比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05),具有可比性。比較兩組手術(shù)時(shí)間、術(shù)中失血量、住院時(shí)間。攝胸腰椎X線片,測(cè)量后凸Cobb角、傷椎高度和運(yùn)動(dòng)范圍。采用Greenough腰痛評(píng)分法和疼痛視覺模擬評(píng)分(VAS)評(píng)價(jià)患者腰部功能恢復(fù)情況,參照ASIA分級(jí)標(biāo)準(zhǔn)評(píng)估神經(jīng)功能恢復(fù)情況。結(jié)果與融合組相比,非融合組手術(shù)時(shí)間縮短、術(shù)中失血量減少,差異有統(tǒng)計(jì)學(xué)意義(P0.05);兩組住院時(shí)間比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者均獲隨訪;融合組隨訪時(shí)間為2.0~3.5年,平均3.17年;非融合組為2~4年,平均3.23年。X線片復(fù)查示,融合組2例植骨未達(dá)融合;其余25例均融合,融合時(shí)間12~17周,平均15.6周。術(shù)后融合組2例、非融合組1例出現(xiàn)切口相關(guān)并發(fā)癥,其余切口均Ⅰ期愈合。兩組術(shù)前、術(shù)后即刻及末次隨訪時(shí)Cobb角、傷椎高度比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后1年(取出內(nèi)固定物前),兩組傷椎運(yùn)動(dòng)范圍比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05);非融合組術(shù)后1年均出內(nèi)固定物,融合組術(shù)后1年時(shí)11例取出內(nèi)固定物;末次隨訪時(shí)非融合組傷椎運(yùn)動(dòng)范圍較融合組顯著增加,比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。末次隨訪時(shí),融合組與非融合組Greenough腰痛評(píng)分法評(píng)分、VAS評(píng)分以及ASIA分級(jí)比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論后路短節(jié)段椎弓根螺釘固定治療胸腰椎爆裂骨折時(shí)無需進(jìn)行融合,以保留傷椎運(yùn)動(dòng)功能,縮短手術(shù)時(shí)間,減少術(shù)中失血,避免取髂骨區(qū)相關(guān)并發(fā)癥的發(fā)生。
[Abstract]:Objective to compare the effect of posterior short-segment pedicle screw fixation and non-fusion in the treatment of thoracolumbar burst fracture. Methods from February 2012 to February 2014, 57 patients with single thoracolumbar burst fractures were treated with posterior short segmental pedicle screw fixation. Among them, 27 cases underwent fusion (fusion group) and 30 cases did not perform fusion (non-fusion group). There was no significant difference between the two groups in sex, age, cause of injury, time from injury to admission, fracture segment and classification, (ASIA) grading of the American Association of Spinal Cord injury (Asci) and so on (P0.05), there was no significant difference between the two groups (P0.05). The operative time, blood loss and hospitalization time were compared between the two groups. X-ray film of thoracolumbar vertebrae was used to measure Cobb angle of kyphosis, height and range of motion of injured vertebrae. Low back pain score (Greenough) and visual analogue pain score (VAS) were used to evaluate the recovery of lumbar function, and the neurological function was evaluated according to the standard of ASIA. Results compared with the fusion group, the operative time and blood loss in the non-fusion group were shortened, the difference was statistically significant (P0.05); there was no significant difference in hospitalization time between the two groups (P0.05). The mean follow-up time was 3.17 years in the fusion group, 2.0-3.5 years in the fusion group, and 3.23 years in the non-fusion group. X-ray examination showed that two patients in the fusion group were not fused and the other 25 cases were fused for 1217 weeks with an average of 15.6 weeks. Postoperative fusion group (2 cases) and non fusion group (1 case) had incision-related complications. There was no significant difference in Cobb angle and the height of injured vertebrae between the two groups before operation, immediately after operation and at the last follow-up (P0.05). 1 year after operation (before removal of internal fixator), there was no significant difference between the two groups in the range of injured vertebrae motion (P0.05). In the non-fusion group, the internal fixation was taken out 1 year after operation, and in the fusion group, the internal fixation was removed in 11 cases at 1 year after operation. At the last follow-up, the range of injured vertebrae in non-fusion group was significantly higher than that in fusion group, and the difference was statistically significant (P0.05). At the last follow-up, there was no significant difference in Greenough low back pain score, VAS score and ASIA score between fusion group and non-fusion group (P0.05). Conclusion there is no need for fusion in the treatment of thoracolumbar burst fractures with posterior short segmental pedicle screw fixation, in order to preserve the motor function of injured vertebrae, shorten the operation time, reduce intraoperative blood loss and avoid the complications associated with iliac bone extraction.
【作者單位】：西南醫(yī)科大學(xué)附屬醫(yī)院脊柱外科;
【分類號(hào)】：R687.32

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