两种方法治疗胸腰椎爆裂骨折的临床疗效分析(1)
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[摘要] 目的 比较两种方法治疗胸腰椎爆裂骨折的疗效。方法 传统6钉法多节段固定椎体26例(A组)与经骨折椎体椎弓根置钉并椎体内植骨的6钉法固定椎体21例(B组)进行疗效比较，观察术前、术后10周和随访12个月椎体压缩率及Cobb角的变化。结果 Cobb角及椎体压缩率在术后10周两组间比较无显著性差异(P>0.05)，但在术后12个月两组间比较均有统计学意义(P<0.05)。结论 胸腰椎爆裂骨折经伤椎椎弓根置钉并椎体内植骨的6钉法固定可有效恢复并维持椎体高度，减少后凸畸形的发生。
[关键词] 胸腰椎骨折；经椎弓根植骨；内固定
[中图分类号] R687.3 [文献标识码] B [文章编号] 1673-9701(2011)32-36-02
The Curative Effect Analysis of Thoracic and Lumber Vertebrae Burst Fracture with Two Treatment Methods
ZHANG Jun WANG Zhongxia CHEN Kai TANG Zhipeng CHEN Maoxi
Department of Orthopedics，the People's Hospital of Fenghua，Fenghua 315500， China
[Abstract] Objective To compare two methods treatment of thoracolumbar burst fracture. Methods Fourty-seven cases with thoracolumbar fracture were analyzed re-trospectively. The patients were divided into two groups，observed changes of Vertebral compression ratio and Cobb angle in the preoperative，10 weeks and 12 months after postoperatively. Results There were no significant differences about Vertebral compression ratio and Cobb angle between two groups postoperative 10 weeks. But there were significant differences postoperative 12 months. Conclusion It can effective restore and maintain vertebral bodys height，reduce the occurrence of kyphose deformity that the treatment of thoracolumbar burst fracture with internal fixation of 6 nail method and bone graft through pedicle of fractured vertebra.
[Key words] Thoracolumbar fracture；Pass through pedicle of vertebral arch bone graft；Internal fixation
椎体爆裂骨折指椎体的前中柱在轴向应力下椎体及椎间盘向两侧移位，致两侧椎弓根距离加宽，并常伴有后柱损伤。随着交通业及建筑业的快速发展，胸腰椎爆裂骨折的发病率逐年提高[1]。这些高能量的损伤也使骨折的损伤机制和类型变的更加复杂，常合并扭转和侧屈暴力，并伴有移位和脱位，导致腰椎极度不稳，常需多节段固定，2009年1月～2010年10月我院尝试经骨折椎体椎弓根置钉椎体内植骨的6钉法固定椎体21例，取得良好疗效，并与传统6钉法固定椎体26例进行比较，现报道如下。
1 资料与方法
1.1 一般资料
本组患者47例，男34例，女13例；年龄20～64岁，平均年龄38.6岁。致伤原因：车祸伤32例，高处坠落伤11例，压砸伤4例。骨折部位：T11骨折4例，T12骨折10例，L1骨折23例，L2骨折10例。椎管内狭窄12%～80%不等，按Denis分型均属于爆裂骨折，所有纳入病例均为单节段骨折，单侧或者双侧椎弓根完整。受伤至手术时间6～72h，平均33h。神经损伤情况按Frankel分级标准：A级5例，B级8例，C级4例，D级16例，E级14例。将47例患者随机分为A、B两组，其中A组采用传统6钉法固定椎体26例，B组采用经骨折椎体椎弓根置钉椎体内植骨的6钉法固定椎体21例。两组患者在年龄、性别、Denis分型、神经损伤情况、受伤至手术时间等均无差异。入选标准：手术均由同一施术者完成，无严重并发症发生。
1.2 手术方法
手术均由固定的医师完成，患者全身麻醉，俯卧位于腰椎手术床上，胸部及双侧髂前上棘垫枕，腹部悬空，先以C-臂机定位伤椎 ......
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