| 李锦华,周鹰飞*,赵宙,李安军,杨祖清.经伤椎和跨伤椎内固定治疗不同程度胸腰椎骨折[J].脊柱外科杂志,2019,17(4):252-256. |
经伤椎和跨伤椎内固定治疗不同程度胸腰椎骨折  点此下载全文 (Fulltext) |
| 李锦华 周鹰飞* 赵宙 李安军 杨祖清 |
| 湖北医药学院十堰市人民医院脊柱外科, 十堰 442000 |
| 基金项目：2016年十堰市科学技术研究与开发项目（16Y45） |
| DOI：10.3969/j.issn.1672-2957.2019.04.007 |
| 摘要点击次数: 673 |
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| 摘要： |
| 目的 对比经伤椎和跨伤椎内固定治疗不同程度胸腰椎骨折患者的临床疗效。方法 回顾性分析2014年1月—2015年12月收治的110例胸腰椎骨折病例，其中采用跨伤椎内固定55例（A组），经伤椎内固定55例（B组）。根据胸腰椎骨折伤椎形态量表将骨折程度分为轻、中、重度。分别于术前、术后5 d、取出内固定后7 d测量患者的Cobb角、伤椎压缩率及伤椎相邻上下位椎间隙高度，并计算矫形丢失率，骨折程度相同的患者进行组间比较。术后1年采用SF-36评分评估患者生活质量。结果 所有患者随访12~24（18.29±0.22）个月。轻度胸腰椎骨折患者，术后及内固定取出后2组间Cobb角、伤椎压缩率、伤椎相邻上下位椎间隙高度及矫形丢失率差异均无统计学意义（P>0.05）。中度胸腰椎骨折患者，内固定取出后B组Cobb角和伤椎压缩率均优于A组，矫形丢失率低于A组，差异具有统计学意义（P<0.05）。重度胸腰椎骨折患者，内固定取出后相邻上位椎间隙高度低于术后；内固定取出后B组Cobb角、伤椎压缩率及相邻上位椎间隙高度均优于A组，矫形丢失率也低于A组；差异均有统计学意义（P<0.05）。B组术后1年SF-36评分总体高于A组，差异具有统计学意义（P<0.05）。结论 对于轻度胸腰椎骨折患者，无需行伤椎内固定；对于中度或重度胸腰椎骨折患者，行经伤椎内固定能有效降低矫形丢失率，提高患者生活质量，取得良好的治疗效果。 |
| 关键词：胸椎 腰椎 脊柱骨折 内固定器 |
| Treatment for different degree thoracolumbar fracture by trans- or cross-injured vertebra internal fxation Fulltext |
| LI Jin-hua ZHOU Ying-fei* ZHAO Zhou LI An-jun YANG Zu-qing |
| Department of Spinal Surgery, Shiyan Peoples'Hospital, Hubei University of Medicine, Shiyan 442000, Hubei, China |
| Fund Project: |
| Abstract: |
| Objective To compare the clinical effect of trans-injured vertebra internal fixation and cross-injured vertebra in ternal fixation in the treatment for different degree thoracolumbar fracture. Methods From January 2014 to December 2015, 110 cases of thoracolumbar fracture were analyzed retrospectively. Among them, 55 were treated with cross-injured vertebra in ternal fixation(group A) and 55 with cross-injured vertebra internal fixation(group B). The degree of fracture was divided in to mild, moderate and severe according to the thoracolumbar vertebral morphology scale. The Cobb's angle, compression rate and adjacent upper/lower vertebral space height of injured vertebra were measured at pre-operation, postoperative 5 d and 7 d after removal of internal fixation. The loss rate of correction was calculated. The patients with the same degree of fracture were compared between the 2 groups. The SF-36 score of patients' quality of life was evaluated at postoperative 1 year. Results All the patients were followed up for 12-24(18.29±0.22) months. There was no significant difference in Cobb's angle, compression rate, height of adjacent upper and lower intervertebral space after operation and after removal of internal fixation and loss rate of correction between the 2 groups in patients with mild thoracolumbar fracture(P>0.05). In the patients with moderate thoracolumbar fracture, the Cobb's angle and compression rate of injured vertebrae in group B were better than those in group A after removal of internal fixation, and the loss rate of correction was lower than that in group A, with statistical significance(P<0.05). In the patients with severe thoracolumbar fracture, the height of adjacent upper intervertebral space after removal of internal fixation was lower than that after operation, and the difference was statistically significant(P<0.05); Cobb's angle, compression rate of injured vertebra and height of adjacent upper intervertebral space in group B after removal of in ternal fixation were better than those in group A, and the loss rate of correction was also lower than that in group A, and the differences were statistically significant(P<0.05). The SF-36 score of patients' quality of life at postoperative 1 year in group B was higher than that in group A, and the difference was statistically significant(P<0.05). Conclusion For the patients with mild thoracolumbar fractures, there is no need for trans-injured vertebra internal fixation; for the patients with moderate or severe thoracolumbar fractures, trans-injured vertebra internal fixation can effectively reduce the loss rate of correction, improve the quality of life of patients, and achieve good therapeutic effect. |
| Keywords:Thoracic vertebrae Lumbar vertebrae Spinal fractures Internal fixators |
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