跨伤椎固定和经伤椎固定治疗胸腰椎骨折对椎体高度和侧弯角度改善效果比较［摘要］目的探讨跨伤椎固定与经伤椎固定治疗胸腰椎骨折对椎体高度及侧弯角度改善的效果。方法选择本院2010年1月〜2012年12月收治的63例胸腰椎骨折患者，按治疗方法分为两组，33例采用椎弓根螺钉跨伤椎固定治疗为A组，30例采用经伤椎固定治疗为B组，观察两组术前、术后、随访1年时的Cobb角、椎体前缘高度，随访观察两组患者的植骨融合率、脊髓神经恢复及局部疼痛情况。结果患者术后随访均满1年，平均14.5个月。术后5d,两组Cobb角、椎体前缘高度比较，差异无统计学意义。随访1年时，两组椎体前缘高度比较差异无统计学意义；两组Cobb角比较，差异有统计学意义；内固定取出后A组Cobb角矫正度丢失更明显。随访显示，A组植骨融合率明显低于B组，差异有统计学意义。术后1年时两组脊髓神经功能恢复差异无统计学意义，但B组局部疼痛方面优于A组。结论经伤椎固定治疗胸腰椎骨折在植骨融合、脊柱矫正度维持及局部疼痛方面较跨伤椎固定有明显优势，值得应用。［关键词］胸腰椎骨折；固定；椎体前缘髙度；Cobb角［中图分类号］R683.2［文献标识码］A［文章编号］1674-4721(2013)11(c)—0049—03Effectcomparisonofconsecutivepediclescrewfixationandshort-segmentpediclescrewfixationinvertebralbodyheightandscoliosisangleimprovementofthoracolumbarfractureHUANGJin-pingWANGJinHEFu-pingPeople7sHospitalofJinxiCountyinJiangxiProvince,Jinxi344800,China[Abstract]ObjectiveToinvestigatetheeffectofconsecutivepediclescrewfixationandshort—segmentpediclescrewfixationintebralbodyheightandscoliosisangleimprovementofthoracolumbarfracture・Methods63patientswiththoracolumbarfracturesinourhospitalfromJanuary2010toDecember2012wereselectedanddividedintotwogroupsaccordingtothetreatmentmethods,33casestreatedwithconsecutivepediclescrewfixationwereselectedasgroupA,30casestreatedwithshort-segmentpediclescrewfixationwereselectedasgroupB，thepreoperative，postoperative，andCobbangle1-yearfollowed-upandvertebralheightwereobserved,thebonegraftfusionrate,spinalnerverecoveryandlocalpainoftwogroupswereobserved・ResuItsPatientswerefollowedupforatleast1year,withanaverageof14.5months・Fivedaysaftersurgery,Cobbangleandvertebralheightoftwogroupscompared,thedifferencewasnotstatisticallysignificant.After1-yearfollowed—up，vertebralheightoftwogroupswasnotsignificantlydifferent(P>0.05),Cobbangleoftwogroupswassignificantlydifferent,CobbangleofgroupAhadmorepronouncedlossofcorrection.Thefoilow-upshowedfusionrateofgroupAwassignificantlylowerthanthatofgroupB,thedifferencewasstatisticallysignificant・Thespinalcordnervefunctionrecoveryoftwogroupswasnosignificantlydifferent，butlocalpainofgroupBwassuperiortogroupA.ConclusionTheinjuredvertebrafixationforthoracolumbarfracturesinthebonegraftfusionthespinalcorrectionmaintainthancrosslocalizedpainintheinjuredvertebrafixedthereareobviousadvantagesworthApplicationdegrees・[Keywords]Thoracolumbarfractures；Fixtion；Vertebralheight；Cobbangle胸腰椎骨折是临床骨科较常见的损伤，多由于撞、压等直接外力或高处坠落间接外力所致，病情严重者可直接导致截瘫。目前临床治疗中椎弓根螺钉系统跨伤椎体两椎体固定应用较多，但临床实践发现，患者术后多存在矫正度丢失及内固定失效的现象[1-2]o为维持脊柱矫正度及伤椎高度，近年来临床出现采用经伤椎多椎体固定的报道，效果良好。本研究回顾性分析本院采用上述两种固定治疗的患者的临床资料，现报道如下。1资料与方法1.1一般资料选择本院2010年1月〜2012年12月收治的63例胸腰稚骨折患者的临床及随访资料，患者均为单椎体骨折，排除骨质疏松、合并肿瘤、营养不良、感染性疾病者。男43例,女20例，年龄22〜59岁，平均（38.6±10...