第一临床医学院知识库

椎骨折是骨科临床中最为常见的脊柱损伤，胸腰段骨折常合并程度不同的脊髓损伤与神经损伤，致残率较高。数十年来,随着现代医疗技术的快速进步，通过手术方法治疗胸腰椎骨折取得了很大的进展。本研究通过观察比较经伤椎与跨伤椎后路椎弓根螺钉复位疗效，以期为临床治疗胸腰椎骨折选择出一种更安全且有效的治疗方法。方法：通过回顾分析2012年6月至2015年6月来自兰州石化总医院收治的52例单节段胸腰椎骨折患者的临床资料，随机将患者分为对照组与治疗组，每组各26例。患者纳入标准：（1）有明确的外伤史，X线或CT检查显示单节段胸、腰椎骨折；（2）伤椎位于T10-L3；（3）Denis胸腰椎骨折分型为胸腰椎爆裂型骨折或胸腰椎压缩型骨折；（4）获随访1年以上。排除标准：（1）陈旧性骨折（受伤时间超过3周）、病理性骨折、多节段胸腰椎损伤、伤椎双侧椎弓根断裂、椎管内有游离翻转的骨折块、并发有严重颅脑和胸腔、腹腔内重要脏器损伤者，以及其他全身性疾病不能耐受或延期手术者以及不明原因的骨折类型；（2）合并有严重心肝肾等基础疾病患者、脊髓完全损伤者；（3）存在明显感染灶。治疗组手术方式采用经伤椎后路椎弓根螺钉复位固定治疗，对照组手术方法采用跨伤椎后路椎弓根螺钉复位固定治疗。采用Frankel分级对患者术前、术后脊髓神经功能改善情况进行评价，采用Denis分级评价术前、术后患者腰背痛改善情况，并比较两组患者手术时间、术中出血量以及手术前、手术后、术后1年的伤椎椎体前、后缘高度比和Cobb’s角。结果：（1）手术时间、术中出血量及术后卧床时间比较。治疗组和对照组患者平均手术时间分别为（179.2±22.5）min和（162.5±27.8）min，平均术中出血量为（320.6±55.2）mL和（258.3±49.7）mL，对照组患者平均手术时间和术中出血量优于治疗组（P＜0.05）；治疗组和对照组患者手术后卧床时间分别为（4.6±0.5）d和（5.4±0.5）d，手术后卧床时间的比较治疗组患者明显优于对照组（P＜0.05）。（2）Frankel分级和Denis分级比较。两组患者的疼痛程度和功能恢复情况的比较均是术后明显优于术前（P＜0.05）；患者术后腰背部疼痛分级和神经功能恢复情况的比较是治疗组明显优于对照组，组间比较差异具有显著性（P＜0.05）。（3）手术伤椎椎体前、后缘高度比和Cobb’s角与手术前相比，两组患者术后伤椎椎体前、后缘高度比和Cobb’s 角均明显改善（P＜0.05），组间比较差异无显著性（P＞0.05）；术后1年随访发现，治疗组患者的伤椎椎体前后缘高度比和Cobb’s角均明显优于对照组（P＜0.05），差异具有统计学意义。结论：经伤椎椎弓根螺钉复位治疗胸腰椎骨折复位满意,能有效阻止后期椎体高度丢失，疗效满意，能够有效缓解患者疼痛程度，促进患者功能恢复，而且远期疗效明显优于传统跨伤椎后路椎弓根螺钉复位治疗，值得推广应用。

Objective:Thoracic lumbar fractures are the most common spinal injuries in the clinic, and the thoracic lumbar segment often incorporates varying degrees of spinal cord injury and neurological impairment, and the disability rate is higher. With the rapid progress of medical technology, surgical treatment of thoracolumbar fractures have also made great progress.In this study, we compared the treatment of thoracolumbar vertebrae fractures by comparing the curative effect of vertebral and pedicle screw fixation.Methods: The clinical data of 52 patients with thoracic lumbar fractures from June 2012 to June 2015 were retrospectively divided into the control group and the treatment group, with 26 cases in each group.Patients were included in the standard: (1) a clear history of trauma, X-ray or CT examination showed a single segment of the chest, lumbar fractures; (2) injury in the T10-L3; (3) Denis thoracolumbar fractures were thoracolumbar burst Type fractures or compression fractures; (4) were followed up for more than 1 year.Exclusion criteria: (1) old fractures, multiple stages of injury and unexplained fracture type; (2) combined with severe heart and kidney and other underlying diseases; (3) the presence of signifiGcant infection.The treatment group was treated with the treatment of vertebral pedicle screw fixation and fixed treatment. The control group was treated with cross-posterior pedicle screw fixation. The improvement of spinal cord function in patients before and after operation was evaluated by Frankel classification. The improvement of low back pain was evaluated by Denis grading, and compare the two groups of patients with operation time, intraoperative blood loss, and before the operation, after surgery, postoperative 1 year after injury vertebral fanterior flange height ratio and Cobb's Angle.Results:(1) Comparison of operation time, intraoperative blood loss and bedtime comparison. The mean operative time was (179.2 ± 22.5) min and (162.5 ± 27.8) min in the treatment group and the control group respectively. The mean intraoperative blood loss was (320.6 ± 55.2) mL and (258.3 ± 49.7) mL respectively. (P＜0.05). The time of bed rest was (4.6 ± 0.5) days and (5.4 ± 0.5) days in the treatment group and the control group, respectively. The time of bed rest was significantly improved in the treatment group and the control group (P＜0.05). (2) Frankel grading and Denis grading comparison. After operation, the pain degree and function recovery of the two groups were significantly better than those before treatment (P＜0.05). The postoperative treatment of patients with lower back pain and neurological function were significantly better than those of the control group. Significant (P＜0.05). (3) the height of the anterior and posterior margin of the vertebral body and the Cobb's angle. (P＜0.05). There was no significant difference between the two groups (P＞0.05). There was no significant difference between the two groups (P＞0.05). There was no significant difference between the two groups (P＞0.05) (P＜0.05), and the difference was statistically significant (P＜0.05). The difference between the anteroposterior height and the Cobb's angle was significantly higher in the treatment group than in the control group (P＜0.05).Conclusion:The treatment of thoracolumbar fractures with vertebral pedicle screw reduction is effective, can effectively relieve the pain of patients and promote the recovery of patients, and the long-term effect is better than the traditional transected pedicle screw replacement treatment, it is worth promoting application.