伤椎置钉联合短节段内固定与单纯短节段固定治疗胸腰椎爆裂性骨折的比较研究

目的:比较伤椎置钉联合短节段内固定与单纯短节段固定治疗胸腰椎爆裂性骨折的临床疗效、固定效果及其对患者炎症反应和脊髓损伤的影响。方法:选取2014年3月到2016年12月期间我院收治的胸腰椎爆裂性骨折患者94例,根据手术方法的不同将患者分为伤椎置钉组(40例)和短节段内固定组(44例)。短节段内固定组患者采用单纯后路短节段椎弓根螺钉内固定进行治疗,伤椎置钉组采用伤椎置钉联合后路短节段椎弓根螺钉内固定进行治疗。比较两组患者的手术时间、术中出血量、住院时间、伤椎前沿高度比、Cobb’s角、伤椎椎体楔形变角、视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI),炎性因子指标、脊髓损伤指标及术后并发症。结果:伤椎置钉组的手术时间长于短节段内固定组(P<0.05),术后6个月、术后12个月伤椎置钉组的伤椎前沿高度比明显高于短节段内固定组,Cobb’s角、伤椎椎体楔形变角明显低于短节段内固定组(P<0.05),术前、术后1周、术后6个月、术后12个月两组患者的VAS评分和ODI比较差异无统计学意义(P>0.05),术后3 d两组患者血清中IL-1β、IL-6、IL-8、TNF-α和pNF-H、NSE、S100β、GFAP水平比较差异均无统计学意义(P>0.05)。随访期间两组患者均未出现严重并发症。结论:伤椎置钉联合后路短节段椎弓根螺钉内固定可有效改善胸腰椎爆裂性骨折患者的椎体高度、Cobb’s角和伤椎椎体楔形变角,并且不会增加脊髓损伤和机体的炎症反应。

Comparative Study of Injuried Vertebra Combined with Short Segment Internal Fixation and Simple Short Segment Fixation in the Treatment of Thoracolumbar Burst Fracture

Objective: To compare the clinical effect, the fixation effect and the effect on the inflammatory response and spinal cord injury of injuried vertebra combined with short segment internal fixation and simple short segment fixation in the treatment of patients with thoracolumbar burst fracture. Methods: 94 patients with thoracolumbar burst fracture who were treated in our Hospital from March 2014 to December 2016 were selected, according to the different methods of operation,the patients were divided into the injured vertebra nailing group(40 cases) and the short segment internal fixation group(44 cases). Short segment internal fixation group was treated by simple posterior short segment pedicle screw internal fixation, the injured vertebra nailing group was treated with injuried vertebra combined with posterior short segment internal fixation. The operation time, the amount of intraoperative bleeding, the time of hospitalization, the height ratio of the injured vertebra, the Cobb ’s angle, vertebral wedge angle, visual analogue scale(VAS), Oswestry disability index(ODI), inflammatory factor indexes, spinal cord injury indexes and postoperative complications of patients between the two groups were compared. Results: The operation time of the injured vertebral nailing group was longer than that of the short segment internal fixation group(P<0.05), at 6 months after operation and 12 months after operation, the height ratio of injured vertebrae in the injured vertebral nailing group was significantly higher than that in the short segment internal fixation group, Cobb ’s angle, vertebral wedge angle was significantly lower than that of short segment internal fixation group(P<0.05). There was no significant difference in VAS score and ODI between two groups before operation, 1 weeks after operation, 6 months after operation and 12 months after operation(P>0.05). There was no significant difference in levels of serum IL-1β, IL-6, IL-8, TNF-α and pNF-H, NSE, S100β and GFAP between the two groups at 3 d after operation(P>0.05). During the follow-up period, the patients of two groups had no serious complications. Conclusion: The injuried vertebra combined with posterior short segment fixation can effectively improve vertebral height, Cobb ’s angle and vertebral wedge angle of patients with thoracolumbar burst fracture, and it does not increase spinal cord injury and inflammatory response.