后路長節段與短節段椎弓根螺釘固定治療胸腰椎骨折的療效比較_《中國修復重建外科雜志》

作者：

丁少成 , 曹家俊 , 魏學忠 , 周本學 , 王鳳民

六安市第二人民醫院骨科（安徽六安，237008）;

關鍵詞：

胸腰椎骨折內固定長節段短節段

DOI：

10.7507/1002-1892.20130153

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目的比較后路長節段與短節段椎弓根螺釘固定治療胸腰椎骨折的臨床療效。方法回顧分析2007年1月－2009年12月行后路椎弓根螺釘固定術治療的58例AO分型為B型的胸腰椎骨折患者臨床資料，其中36例行短節段固定（傷椎上、下各1個椎體，A組），22例行長節段固定（傷椎上、下各2個椎體，B組）。兩組患者性別、年齡、致傷原因、骨折部位、術前神經功能Frankel分級、受傷至手術時間等一般資料比較，差異均無統計學意義（P gt; 0.05），具有可比性。比較兩組手術時間、術中出血量、并發癥發生情況以及椎體前緣壓縮度、Cobb角等指標，術后神經功能采用Frankel分級評定。結果 B組手術時間及術中出血量顯著高于A組（P lt; 0.05）。術后患者切口均Ⅰ期愈合；患者均獲隨訪，隨訪時間12～32個月，平均17.2個月。隨訪期間A組有1例內固定失敗和1例后凸畸形加重，其余患者均無并發癥發生。兩組術后神經功能均有一定程度恢復，術后3個月Frankel分級均較術前顯著提高（P lt; 0.05）；兩組比較差異無統計學意義（Z=0.09，P=0.36）。兩組術后即刻及末次隨訪時椎體前緣壓縮度及Cobb角均較術前顯著改善（P lt; 0.05）。B組術后即刻及末次隨訪時椎體前緣壓縮矯正率及Cobb角矯正率均明顯高于A組（P lt; 0.05），B組末次隨訪時椎體前緣矯正丟失度及Cobb角矯正丟失度明顯小于A組（P lt; 0.05）。結論采用后路長節段椎弓根螺釘固定治療胸腰椎骨折術中出血量及手術時間明顯增加，但在恢復椎體高度、矯正后凸畸形、預防遠期矯正丟失方面明顯優于短節段固定。

引用本文： 丁少成,曹家俊,魏學忠,周本學,王鳳民. 后路長節段與短節段椎弓根螺釘固定治療胸腰椎骨折的療效比較. 中國修復重建外科雜志, 2013, 27(6): 690-695. doi: 10.7507/1002-1892.20130153 復制

1.	Alanay A, Acaroglu E, Yazici M, et al. Short-segment pedicle instrumentation of thoracolumbar burst fractures: does transpedicular intracorporeal grafting prevent early failure? Spine (Phila Pa 1976), 2001, 26(2): 213-217.
2.	Alvine GF, Swain JM, Asher MA, et al. Treatment of thoracolumbar burst fractures with variable screw placement or Isola instrumentation and arthrodesis: case series and literature review. J Spinal Disord Tech, 2004, 17(4): 251-264.
3.	Knop C, Bastian L, Lange U, et al. Complications in surgical treatment of thoracolumbar injuries. Eur Spine J, 2002, 11(3): 214-216.
4.	Wood KB, Bohn D, Mehbod A. Anterior versus posterior treatment of stable thoracolumbar burst fractures without neurologic deficit: a prospective, randomized study. J Spinal Disord Tech, 2005, 18 Suppl: S15-23.
5.	Denis F. The three column spine and its significance in the classification of acute thoracolumbar spine injuries. Spine (Phila Pa 1976), 1983, 8(8): 817-831.
6.	王偉, 尹宗生, 張輝, 等. 椎管減壓在胸腰段骨折后路手術中的療效評價. 中國修復重建外科雜志, 2011, 25(1): 84-86.
7.	Denis F, Armstrong GW, Searls K, et al. Acute thoracolumbar burst fractures in the absence of neurologic deficit. A comparison between operative and nonoperative treatment. Clin Orthop Relat Res, 1984, (189): 142-149.
8.	Altay M, Ozkurt B, Aktekin CN, et al. Treatment of unstable thoracolumbar junction burst fractures with short- or long-segment posterior fixation in magerl type a fractures. Eur Spine J, 2007, 16(8): 1145-1155.
9.	McLain RF. The biomechanics of long versus short fixation for thoracolumbar spine fractures. Spine (Phila Pa 1976), 2006, 31(11 Suppl): S70-79, S104.
10.	Gelb D, Ludwig S, Karp JE, et al. Successful treatment of thoracolumbar fractures with short-segment pedicle instrumentation. J Spinal Disord Tech, 2010, 23(5): 293-301.
11.	Parker JW, Lane JR, Karaikovic EE, et al. Successful short-segment instrumentation and fusion for thoracolumbar spine fractures: a consecutive 41/2-year series. Spine (Phila Pa 1976), 2000, 25(9): 1157-1170.
12.	McLain RF, Sparling E, Benson DR. Early failure of short-segment pedicle instrumentation for thoracolumbar fractures. A preliminary report. J Bone Joint Surg (Am), 1993, 75(2): 162-167.
13.	Kramer DL, Rodgers WB, Mansfield FL. Transpedicular instrumentation and short-segment fusion of thoracolumbar fractures: a prospective study using a single instrumentation system. J Orthop Trauma, 1995, 9(6): 499-506．.
14.	Tezeren G, Kuru I. Posterior fixation of thoracolumbar burst fracture: short-segment pedicle fixation versus long-segment instrumentation. J Spinal Disord, 2005, 18(6): 485-488.
15.	McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine (Phila Pa 1976), 1994, 19(15): 1741-1744.
16.	Tezeren G, Bulut O, Tukenmez M, et al. Long segment instrumentation of thoracolumbar burst fracture: fusion versus nonfusion. J Back Musculoskelet Rehabil, 2009, 22(2): 107-112.
17.	Verlaan JJ, Diekerhof CH, Buskens E, et al. Surgical treatment of traumatic fractures of the thoracic and lumbar spine: a systematic review of the literature on techniques, complications, and outcome. Spine (Phila Pa 1976), 2004, 29(7): 803-814.
18.	魏富鑫, 崔尚斌, 李廣勝, 等. 單、雙運動單元固定治療胸腰椎骨折的療效比較. 中華骨科雜志, 2012, 32(4): 309-316.
19.	Dick JC, Jones MP, Zdeblick TA, et al. A biomechanical comparison evaluating the use of intermediate screws and cross-linkage in lumbar pedicle fixation. J Spinal Disord, 1994, 7(5): 402-407.
20.	羅一, 鄧展生, 陳靜. 不同植骨融合方式對胸腰椎爆裂性骨折療效的影響. 中國修復重建外科雜志, 2011, 25(11): 1302-1307.

1. Alanay A, Acaroglu E, Yazici M, et al. Short-segment pedicle instrumentation of thoracolumbar burst fractures: does transpedicular intracorporeal grafting prevent early failure? Spine (Phila Pa 1976), 2001, 26(2): 213-217.
2. Alvine GF, Swain JM, Asher MA, et al. Treatment of thoracolumbar burst fractures with variable screw placement or Isola instrumentation and arthrodesis: case series and literature review. J Spinal Disord Tech, 2004, 17(4): 251-264.
3. Knop C, Bastian L, Lange U, et al. Complications in surgical treatment of thoracolumbar injuries. Eur Spine J, 2002, 11(3): 214-216.
4. Wood KB, Bohn D, Mehbod A. Anterior versus posterior treatment of stable thoracolumbar burst fractures without neurologic deficit: a prospective, randomized study. J Spinal Disord Tech, 2005, 18 Suppl: S15-23.
5. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spine injuries. Spine (Phila Pa 1976), 1983, 8(8): 817-831.
6. 王偉, 尹宗生, 張輝, 等. 椎管減壓在胸腰段骨折后路手術中的療效評價. 中國修復重建外科雜志, 2011, 25(1): 84-86.
7. Denis F, Armstrong GW, Searls K, et al. Acute thoracolumbar burst fractures in the absence of neurologic deficit. A comparison between operative and nonoperative treatment. Clin Orthop Relat Res, 1984, (189): 142-149.
8. Altay M, Ozkurt B, Aktekin CN, et al. Treatment of unstable thoracolumbar junction burst fractures with short- or long-segment posterior fixation in magerl type a fractures. Eur Spine J, 2007, 16(8): 1145-1155.
9. McLain RF. The biomechanics of long versus short fixation for thoracolumbar spine fractures. Spine (Phila Pa 1976), 2006, 31(11 Suppl): S70-79, S104.
10. Gelb D, Ludwig S, Karp JE, et al. Successful treatment of thoracolumbar fractures with short-segment pedicle instrumentation. J Spinal Disord Tech, 2010, 23(5): 293-301.
11. Parker JW, Lane JR, Karaikovic EE, et al. Successful short-segment instrumentation and fusion for thoracolumbar spine fractures: a consecutive 41/2-year series. Spine (Phila Pa 1976), 2000, 25(9): 1157-1170.
12. McLain RF, Sparling E, Benson DR. Early failure of short-segment pedicle instrumentation for thoracolumbar fractures. A preliminary report. J Bone Joint Surg (Am), 1993, 75(2): 162-167.
13. Kramer DL, Rodgers WB, Mansfield FL. Transpedicular instrumentation and short-segment fusion of thoracolumbar fractures: a prospective study using a single instrumentation system. J Orthop Trauma, 1995, 9(6): 499-506．.
14. Tezeren G, Kuru I. Posterior fixation of thoracolumbar burst fracture: short-segment pedicle fixation versus long-segment instrumentation. J Spinal Disord, 2005, 18(6): 485-488.
15. McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine (Phila Pa 1976), 1994, 19(15): 1741-1744.
16. Tezeren G, Bulut O, Tukenmez M, et al. Long segment instrumentation of thoracolumbar burst fracture: fusion versus nonfusion. J Back Musculoskelet Rehabil, 2009, 22(2): 107-112.
17. Verlaan JJ, Diekerhof CH, Buskens E, et al. Surgical treatment of traumatic fractures of the thoracic and lumbar spine: a systematic review of the literature on techniques, complications, and outcome. Spine (Phila Pa 1976), 2004, 29(7): 803-814.
18. 魏富鑫, 崔尚斌, 李廣勝, 等. 單、雙運動單元固定治療胸腰椎骨折的療效比較. 中華骨科雜志, 2012, 32(4): 309-316.
19. Dick JC, Jones MP, Zdeblick TA, et al. A biomechanical comparison evaluating the use of intermediate screws and cross-linkage in lumbar pedicle fixation. J Spinal Disord, 1994, 7(5): 402-407.
20. 羅一, 鄧展生, 陳靜. 不同植骨融合方式對胸腰椎爆裂性骨折療效的影響. 中國修復重建外科雜志, 2011, 25(11): 1302-1307.

《中國修復重建外科雜志》

后路長節段與短節段椎弓根螺釘固定治療胸腰椎骨折的療效比較

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《中國修復重建外科雜志》

后路長節段與短節段椎弓根螺釘固定治療胸腰椎骨折的療效比較

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