后路长节段与短节段椎弓根螺钉固定治疗胸腰椎骨折的疗效比较_《中国修复重建外科杂志》

作者：

丁少成 , 曹家俊 , 魏学忠 , 周本学 , 王凤民

六安市第二人民医院骨科（安徽六安，237008）;

关键词：

胸腰椎骨折内固定长节段短节段

DOI：

10.7507/1002-1892.20130153

视频：

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目的比较后路长节段与短节段椎弓根螺钉固定治疗胸腰椎骨折的临床疗效。方法回顾分析2007年1月－2009年12月行后路椎弓根螺钉固定术治疗的58例AO分型为B型的胸腰椎骨折患者临床资料，其中36例行短节段固定（伤椎上、下各1个椎体，A组），22例行长节段固定（伤椎上、下各2个椎体，B组）。两组患者性别、年龄、致伤原因、骨折部位、术前神经功能Frankel分级、受伤至手术时间等一般资料比较，差异均无统计学意义（P gt; 0.05），具有可比性。比较两组手术时间、术中出血量、并发症发生情况以及椎体前缘压缩度、Cobb角等指标，术后神经功能采用Frankel分级评定。结果 B组手术时间及术中出血量显著高于A组（P lt; 0.05）。术后患者切口均Ⅰ期愈合；患者均获随访，随访时间12～32个月，平均17.2个月。随访期间A组有1例内固定失败和1例后凸畸形加重，其余患者均无并发症发生。两组术后神经功能均有一定程度恢复，术后3个月Frankel分级均较术前显著提高（P lt; 0.05）；两组比较差异无统计学意义（Z=0.09，P=0.36）。两组术后即刻及末次随访时椎体前缘压缩度及Cobb角均较术前显著改善（P lt; 0.05）。B组术后即刻及末次随访时椎体前缘压缩矫正率及Cobb角矫正率均明显高于A组（P lt; 0.05），B组末次随访时椎体前缘矫正丢失度及Cobb角矫正丢失度明显小于A组（P lt; 0.05）。结论采用后路长节段椎弓根螺钉固定治疗胸腰椎骨折术中出血量及手术时间明显增加，但在恢复椎体高度、矫正后凸畸形、预防远期矫正丢失方面明显优于短节段固定。

引用本文： 丁少成,曹家俊,魏学忠,周本学,王凤民. 后路长节段与短节段椎弓根螺钉固定治疗胸腰椎骨折的疗效比较. 中国修复重建外科杂志, 2013, 27(6): 690-695. doi: 10.7507/1002-1892.20130153 复制

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.	王伟, 尹宗生, 张辉, 等. 椎管减压在胸腰段骨折后路手术中的疗效评价. 中国修复重建外科杂志, 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, 李广胜, 等. 单、双运动单元固定治疗胸腰椎骨折的疗效比较. 中华骨科杂志, 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.	罗一, 邓展生, 陈静. 不同植骨融合方式对胸腰椎爆裂性骨折疗效的影响. 中国修复重建外科杂志, 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. 王伟, 尹宗生, 张辉, 等. 椎管减压在胸腰段骨折后路手术中的疗效评价. 中国修复重建外科杂志, 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, 李广胜, 等. 单、双运动单元固定治疗胸腰椎骨折的疗效比较. 中华骨科杂志, 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. 罗一, 邓展生, 陈静. 不同植骨融合方式对胸腰椎爆裂性骨折疗效的影响. 中国修复重建外科杂志, 2011, 25(11): 1302-1307.

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后路长节段与短节段椎弓根螺钉固定治疗胸腰椎骨折的疗效比较

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《中国修复重建外科杂志》

后路长节段与短节段椎弓根螺钉固定治疗胸腰椎骨折的疗效比较

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