单双侧伤椎置钉与不置钉在治疗胸腰椎骨折上的病例对照研究
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作者Author单位AddressE-Mail
徐强 XU Qiang 南京医科大学鼓楼临床医学院脊柱外科, 江苏 南京 210008 Department of Spinal Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing 210008, Jiangsu, China  
赵清华 ZHAO Qing-hua 南京医科大学鼓楼临床医学院脊柱外科, 江苏 南京 210008 Department of Spinal Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing 210008, Jiangsu, China  
赵志慧 ZHAO Zhi-hui 南京医科大学鼓楼临床医学院脊柱外科, 江苏 南京 210008 Department of Spinal Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing 210008, Jiangsu, China  
邱勇 QIU Yong 南京医科大学鼓楼临床医学院脊柱外科, 江苏 南京 210008 Department of Spinal Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing 210008, Jiangsu, China  
刘臻 LIU Zhen 南京医科大学鼓楼临床医学院脊柱外科, 江苏 南京 210008 Department of Spinal Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing 210008, Jiangsu, China  
朱泽章 ZHU Ze-zhang 南京医科大学鼓楼临床医学院脊柱外科, 江苏 南京 210008 Department of Spinal Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing 210008, Jiangsu, China zhuzezhang@126.com 
期刊信息:《中国骨伤》2018年,第31卷,第8期,第709-713页
DOI:10.3969/j.issn.1003-0034.2018.08.005
基金项目:
中文摘要:

目的:比较单侧伤椎置钉、双侧伤椎置钉与伤椎不置钉3种置钉方式在后路短节段固定治疗胸腰椎骨折上的临床疗效差异。

方法:自2012年6月至2015年6月,采用后路短节段椎弓根螺钉固定的胸腰椎骨折患者67例,其中男45例,女22例,年龄13~63岁,平均42.5岁。根据伤椎置钉情况将患者分为3组:A组26例,不采用伤椎置钉;B组19例,采用单侧伤椎置钉;C组22例,采用双侧伤椎置钉。观察并比较3组患者的影像学结果及临床预后等各项指标。

结果:所有患者获得随访,时间12~26个月,平均17.6个月。均未出现伤口感染、切口愈合不良及内固定松动断裂等并发症。术前、术后1周及末次随访时3组患者的伤椎前缘相对高度差异无统计学意义(P>0.05)。术前及术后1周伤椎矢状面后凸Cobb角3组间差异无统计学意义(P>0.05)。末次随访时,A组患者的矢状面后凸Cobb角及其复位丢失角度均明显大于B、C两组(P<0.05)。B、C两组之间差异不明显(P>0.05)。背部疼痛的视觉模拟评分(VAS),术前、术后1周及末次随访时3组患者均差异无统计学意义(P>0.05)。

结论:单侧或双侧伤椎置钉与伤椎不置钉相比,在治疗胸腰椎骨折上可以明显降低中远期的复位丢失角度,减少迟发性后凸畸形发生的概率,手术操作安全可靠,可获得满意的影像学结果及临床疗效。
【关键词】胸椎  腰椎  脊柱骨折  骨折固定术,内
 
Case control studies on unilateral or bilateral pedicle fixation at the level of fracture versus posterior fixation alone in the treatment of thoracolumbar fractures
ABSTRACT  

Objective:To compare the clinical effects of three fixation methods at the level of fracture in treating thoracolumbar fractures.

Methods:From June 2012 to June 2015,67 patients with thoracolumbar fractures were treated with posterior short-segment pedicle fixation. There were 45 males and 22 females,aged from 13 to 63 years old with an average of 42.5 years. According to the methods of fixation at the level of fracture,the patients were divided into three groups. Group A included 26 patients treated by traditional posterior fixation alone. Group B included 19 patients treated by posterior fixation with unilateral pedicle fixation at the level of fracture. In group C,22 patients were treated by posterior fixation with bilateral fracture-level screws. Radiological parameters and clinical outcomes were compared among the three groups.

Results:All the patients were followed up for 12 to 26 months with an average of 17.6 months. No complications such as incision infection,poor wound healing,internal fixation loosening and breakage were found. Preoperative,postoperative 1 week,and final follow-up,there were no significance differences among the three groups with respect to the relative height of the fractured vertebra (P>0.05). The sagittal Cobb angles among the three groups were similar preoperatively,and a week after operation (P>0.05). At latest follow-up,the sagittal Cobb angles and the correction loss of Cobb angle in group A were significantly larger than that of groups B and C (P<0.05),while there was no statistical difference between group B and group C (P>0.05). With respect to visual analogue scale (VAS) scores for back pain,the three groups were similar at preoperatively,a week after operation and the latest follow-up(P>0.05).

Conclusion:Compared to traditional posterior fixation alone,unilateral or bilateral pedicle fixation at the level of fracture can significantly decrease the loss of correction in the middle-long term,and reduce the incidence of tardive kyphosis deformity and can obtain satisfactory radiological results and clinical outcomes with safe surgical procedures.
KEY WORDS  Thoracic vertebrae  Lumbar vertebrae  Spinal fractures  Fracture fixation,internal
 
引用本文,请按以下格式著录参考文献:
中文格式:徐强,赵清华,赵志慧,邱勇,刘臻,朱泽章.单双侧伤椎置钉与不置钉在治疗胸腰椎骨折上的病例对照研究[J].中国骨伤,2018,31(8):709~713
英文格式:XU Qiang,ZHAO Qing-hua,ZHAO Zhi-hui,QIU Yong,LIU Zhen,ZHU Ze-zhang.Case control studies on unilateral or bilateral pedicle fixation at the level of fracture versus posterior fixation alone in the treatment of thoracolumbar fractures[J].zhongguo gu shang / China J Orthop Trauma ,2018,31(8):709~713
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