摘要
目的 探讨对于轻度神经损伤的不稳定AO A型胸腰段骨折,不进行减压及融合,单纯行短节段椎弓根螺钉固定手术的疗效. 方法对比分析我院2004年2月-2008年2月手术治疗的AO A型胸腰段骨折（T11～L2）患者42例,分为A组（未植骨组,21例）,予单纯短节段椎弓根螺钉固定,而未行椎板切除减压及植骨;B组（植骨组,15例）,予椎弓根螺钉固定,不进行椎板切除减压但植骨.对两组术前及术后后凸角、椎体压缩高度进行比较分析. 结果 A组术前局部后凸角平均19.1°（15.4°～29.8°）,椎体压缩高度平均46%（30%～63%）;术后局部后凸角5.00（0.3°～10.3°）,椎体压缩高度10%（0～28%）,后凸矫正率79%.平均随访21.2（12～46）个月,随访超过12个月患者21例,末次随访后凸角平均7.0°（1.8°～10.7°）,椎体压缩高度10%（2%～22%）.B组术前局部后凸角平均25.8°（15.9°～34.5°）,椎体压缩高度平均55%（30%～76%）;术后局部后凸角7.1°（1.5°～19.1°）,椎体压缩高度15%（0～28%）,后凸矫正率74%.平均随访17.9（12～31）个月,随访超过12个月患者15例,末次随访后凸角平均8.3°（0.7°～19.2°）,椎体压缩高度15%（1%～26%）,植骨全部愈合,所有患者末次随访时均无明显腰痛症状,无内固定断裂或椎弓根螺钉拔出.后凸角和椎体压缩高度两组间差异无统计学意义.结论 对于一些神经损伤较轻的AO A型胸腰段骨折,在选择椎弓根螺钉固定时,可考虑不进行椎板切除减压,也不行后外侧植骨融合.
Objective To discuss the role of non-fusion without decompression in surgical treatment of unstable AO type A thoracolumbar fractures. Methods A retrospective study was performed on 42 patients with AO type A thoracolumbar fractures （T11-L2） treated with short segment pedicle screw fixation from February 2004 to February 2008. Patients were divided into two groups, ie, Croup A （treated with short segmental pedicle screw fixation without decompression or fusion） and Group B （treated with short segmental pedicle screw fixation without decompression but with fusion）. The pre-operative, postoperative and follow-up local kyphotic angle, vertebrae compression rate were compared between two groups. Results In Croup A, average local kyphotic angle and average vertebrae compression rate were 19.1° （15. 4°-29. 8°） and 46% （30%-63%） respectively before operation, but 5. 0° （0. 3°-10.3°） and 10% （0-28%） respectively after operation. Twenty-one patients were followed up for average 21.2 months （12-46 months）, which showed average local kyphotic angle of 7° （1.8°-10.7°） and average vertebrae compression rate of 10% （2% -22%） at final follow-up. In Croup B, average local kyphotic angle and average vertebrae compression rate were 25.8° （15.9°-34.5°） and 55% （30%-76%） respectively before operation, but 7.1° （1.5°-19. 1°） and 15% （0-28%） respectively after operation. Fifteen patients were followed up for mean 17.9 months （12-31 months） , which showed mean local kyphotic angle of 8.3° （0.7°-19.2°） and average vertebrae compression rate of 15% （l%-26%） at final follow-up. There was no pseudarthrosis, implant breakage, pedicle screw pull-out or severe back pain. There was statistical difference in local kyphotic angle and vertebrae compression rate between two groups.Conclusion Unstable AO type A thoracolumbar fractures with minor neurological deficit can be treated with pedicle screw fixation only without decompression or fusion.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2010年第5期411-414,共4页
Chinese Journal of Trauma
关键词
脊柱骨折
胸椎
腰椎
骨折固定术
内
骨融合
Spinal fractures
Thoracic vertebrae
Lumbar vertebrae
Fracture fixation, internal
Bone fusion
