微创椎弓根螺钉内固定附加伤椎置钉治疗AO-A型胸腰椎骨折的远期疗效观察

Long Term Efficacy of Minimally Invasive Pedicle Screw Fixation plus Pedicle Screw Placement in the Treatment of Thoracolumbar Fractures of Type AO-A

摘要: 目的：探讨微创椎弓根螺钉内固定附加伤椎置钉治疗AO-A型胸腰椎骨折的远期疗效。方法：选择我院骨科2012年1月至2017年12月收治的AO-A型胸腰椎骨折患者80例，将患者随机分为观察组与对照组，每组40例。观察组采用微创椎弓根螺钉内固定附加伤椎置钉治疗，对照组采用微创椎弓根螺钉跨伤椎内固定治疗。随访1年，记录术前、术后1周、术后1年两组患者的伤椎高度和Cob角，用统计学方法予以分析。结果：两组与术前比较，术后1周两组伤椎前后缘高度压缩比升高、Cobb角减小(均P < 0.05)；术前及术后：1周两组组间 伤椎前缘高度压缩比、Cobb角比较差异无统计学意义(均P > 0.05)，术后1年，对照组伤椎前缘高度压缩比、Cobb角[(79.86 ± 4.90)%, (12.75 ± 3.30)˚]与观察组[(91.28 ± 5.10)%, (5.12 ± 1.05)˚]比较差异有统计学意义(均P < 0.05)。结论：微创椎弓根螺钉内固定附加伤椎置钉治疗AO-A型胸腰椎骨折的远期疗效稳定，优于单纯跨伤椎椎弓根螺钉内固定治疗。

Abstract: Objective: To evaluate the long-term effect of minimally invasive pedicle screw fixation combined with vertebral screw placement in the treatment of AO-A thoracolumbar fractures. Methods: Eighty patients with AO-A thoracolumbar fractures from January 2012 to December 2017 in our department of Orthopaedics were randomly divided into observation group and control group, 40 cases in each group. The observation group was treated with minimally invasive pedicle screw fixation and additional intramedullary nailing. The control group was treated with minimally invasive pedicle screw transpedicular internal fixation. The patients were followed up for 1 year. The height of the injured vertebrae and the Cob angle of the two groups before operation, 1 week after surgery and 1 year after surgery were recorded and analyzed by statistical methods. Results: Compared with preoperative, the two groups had higher height compression ratio and Cobb angle of the anterior and posterior margin of the injured vertebrae (P < 0.05). The preoperative and postoperative 1 week group had the intervertebral foramen. There was no significant difference in height compression ratio and Cobb angle (P > 0.05). One year after operation, the height compression ratio and Cobb angle of the anterior edge of the injury in the control group [(79.86 ± 4.90)%, (12.75 ± 3.30)˚] with the observation group [(91.28 ± 5.10)%, (5.12 ± 1.05)˚], the comparative differences are statistically significant (P < 0.05). Conclusions: The minimally invasive pedicle screw fixation combined with vertebral fixation for the treatment of AO-A thoracolumbar fractures has a long-term effect, which is superior to the treatment of pedicle screw fixation.