摘要目的 探讨经皮伤椎置钉纠正胸腰段骨折后凸成角的疗效.方法 采用回顾性病例对照研究分析2010年4月-2015年3月收治的97例无神经症状单节段胸腰椎爆裂骨折患者,均行经皮椎弓根螺钉复位固定术治疗.根据是否行伤椎置钉分为A组(伤椎不置钉组,47例)和B组(伤椎置钉组,50例).每组又根据术前节段后凸角分3个亚组:后凸角≤10°(A1组11例,B1组16例)、后凸角10°～ 20°(A2组20例,B2组16例)、后凸角≥20°(A3组16例,B3组18例).比较两组住院时间、术中出血量、手术时间、视觉模拟评分(VAS)和功能障碍指数(ODI),以及各亚组术前、术后及末次随访节段后凸角、骨折椎体角等影像学指标.结果 患者均获随访12～37个月,平均21.2个月.两组住院时间、术中出血量、VAS及ODI比较,差异均无统计学意义(P＞0.05).A组手术时间为(60.62 ±9.59) min,明显短于B组的(74.78 ± 17.66) min (P ＜0.05).两组均无内固定断裂、失效.两组术前节段后凸角差异无统计学意义(P＞0.05),术后及末次随访节段后凸成角纠正B组为(7.97±5.09)°,优于A组的(3.76±1.67)°(P＜0.05).各亚组中,末次随访时节段后凸角纠正能力A1组与B1组比较差异无统计学意义(P＞0.05),B2组优于A2组(P＜0.05),B3组优于A3组(P＜0.05);末次随访时骨折椎体角纠正能力A1组与B1组差异无统计学意义(P＞0.05),B2组优于A2组(P＜0.05),B3组优于A3组(P＜0.05).节段后凸角及骨折椎体角的角度丢失情况比较中,A3组角度丢失明显大于B3组(P＜0.05).结论 经皮伤椎置钉治疗单节段胸腰段爆裂骨折可获得更大的胸腰段后凸角度纠正效果.当术前节段后凸角≥20°,建议伤椎置钉以达到更好的维持长期后凸纠正效果.

abstractsObjective To investigate the effect of percutaneous lordorizing screws fixation for correcting kyphosis in thoracolumbar burst fractures and treatment strategies.Methods A retrospective case control study was designed to analyze data of 97 patients with single-level thoracolumbar burst fractures without neurological deficits undergone percutaneous lordorizing screw fixation from April 2010 to March 2015.According to the different surgical procedures,the patients were divided into Group A (percutaneous transpedicle fixation,n =47) and Group B (percutaneous transpedicle fixation combine lordorizing screw fixation,n =50).Each group was subdivided based on the preoperative segmental kyphosis:Group A consisted subgroups A1 (kyphosis angle≤ 10°,n =11),A2 (kyphosis angle between 10° and 20°,n =20) and A3 (kyphosis angle ≥ 20°,n =16),and Group B consisted of subgroups B1 (kyphosis angle ≤ 10°,n =16),B2 (kyphosis angle between 10° and 20°,n =16) and B3 (kyphosis angle ≥ 20°,n =18).Length of hospital stay,operation time,blood loss,visual analogue scale (VAS) and Oswestry disability index (ODI) were compared between groups.Segmental kyphosis angle and vertebral wedge angle were compared between subgroups before operation,after operation and at the final follow-up.Results All patients were followed-up for 12-37 months (mean,21.2 months).There were no significant differences between the two groups in aspects of length of hospital stay,blood loss,VAS and ODI (P ＞ 0.05).Operation time was (60.62 ± 9.59) min in Group A,significantly less than that in Group B [(74.78 ± 17.66) min] (P ＜ 0.05).No breakage or malfunction of fixation occurred.There were no significant differences between the two groups in preoperative segmental kyphosis angle (P ＞ 0.05),while the correction of segmental kyphosis angle in Group B was better than Group A at the final follow-up [(7.97 ± 5.09) ° vs.(3.76 ± 1.67) °] (P ＜ 0.05).At the final follow-up,the correction of segmental kyphosis angle was similar between Group A1 and Group B1 (P ＞ 0.05),but the correction in Group B2 was better than GroupA2 (P ＜0.05) and the correction in Group B3 better than Group A3 (P ＜ 0.05).Besides,the correction of vertebral wedge angle was similar between Group A1 and Group B1 (P ＞ 0.05),but the correction in Group B2 was better than Group A2(P ＜0.05) and the correction in Group B3 was better than Group A3 (P ＜ 0.05).Loss of segmental kyphosis angle and vertebral wedge angle in Group A were greater than these in Group B (P ＜ 0.05).Conclusions Combined use of lordorizing screw with percutaneous transvertebral fixation improves the correction of thoracolumbar kyphosis angle in single-level thoracolumbar burst fractures.When the preoperative segmental kyphosis over 20°,lordorizing screw fixation should be recommended so as to achieve better correction of kyphotic deformity.