目的 探讨经伤椎椎弓根撬拨复位联合椎体内植骨治疗胸腰椎压缩骨折的疗效。方法 回顾性分析2010-10至2012-08共49例单节段DenisA型胸腰椎压缩骨折患者在我院手术治疗的病历资料。根据手术方式将其分为A组:23例,采用椎弓根钉棒撑开复位联合撬拨复位椎体内植骨术治疗;B组:26例,采用短节段椎弓根钉撑开固定术治疗。手术前后测量X线片,观察椎体相对高度及后凸角(Cobb角)改善情况,记录手术时间和出血量等数据并进行统计分析。结果 所有手术均顺利完成,切口均一期愈合。B组在手术时间及术中出血量上(130.8±27.7) ml明显低于A组(250.6±51.6) ml,差异有统计学意义(P<0.05);术后1周及末次随访时,两组患者伤椎平均高度和局部Cobb角较术前均有显著恢复(P<0.05);在伤椎平均高度恢复上,A组患者在不同时间点均优于B组(P<0.05);在Cobb角维持上,术后1周时两组比较差异无统计学意义(P>0.05),但末次随访时A组较B组更有优势 (P<0.05);术后两组患者VAS评分均有显著降低(P<0.05),但至末次随访时A组下降程度更大 (P<0.05)。结论 经伤椎椎弓根撬拨复位联合椎体内植骨是治疗胸腰椎压缩骨折的有效方法,可减少椎体矫形高度丢失及空壳样椎体发生。

Objective To study the clinical effect of poking reduction and bone graft on the treatment of thoracolumbar vertebral compression fracture. Methods All of 49 patients who had single segment of thoracolumbar compression fracture underwent operation in the period of October 2010 to August 2012. According to the operation methods, they were divided into 2 groups.Group A (23 patients) underwent poking reduction and bone graft treatment. Group B (26 patients) received short segment pedicle screw fixation. The VAS score, recovery of vertebral body, improvement of Cobb angle, operative time, and blood loss were compared between them. Results All operations were successful without spinal cord and nerves injury. The postoperative follow-up ranged 14-26 months. At 1 week after the operation and at the final follow-up, both of the 2 groups had significant difference in average vertebral height,local Cobb angle, and VAS score when compared with pre-operative level(P<0.05). But group A had advantage in vertebral height restoration, kyphosis angle rectification and VAS score improvement (P<0.05). Conclusions As an effective method for treating thoracolumbar vertebral compression fracture, poking reduction and bone graft have the characteristic of reducing vertebral height loss and avoiding the shell-like vertebral development.