目的：分析比较后路经伤椎短节段与跨伤椎长节段椎弓根螺钉固定治疗胸腰段脊柱爆裂性骨折的效果。方法回顾性分析2011年12月—2014年12月104例单节段胸腰段爆裂性骨折的临床资料，分为经伤椎短节段固定组（短节段组， n=78）与跨伤椎长节段固定组（长节段组，n=26），比较两组的手术时间，出血量，Oswestry功能障碍指数（ODI），疼痛视觉模拟评分（VAS），伤椎前缘高度比值，局部Cobb角，以及并发症等。结果所有患者均获得随访，随访6～36个月，平均（19.8±7.4）个月。长节段组的手术时间及出血量均高于短节段组（均P＜0.05）。末次随访时每组ODI及VAS评分均较术前显著改善（均P＜0.05）；两组间差异均无统计学意义（均P＞0.05）。每组术后即刻伤椎前缘高度比及局部Cobb角较术前显著改善（均P＜0.05），且保持至末次随访（均P＞0.05）；两组间差异均无统计学意义（均P＞0.05）。短节段组伤椎置钉失败2例，两组均无螺钉松动、断裂或移位等并发症。结论经伤椎短节段椎弓根螺钉固定可获得与跨伤椎长节段固定近似的效果，但术中出血量及手术时间减少。%ObjectiveTo investigate the outcomes of short segment pedicle screw instrumentation through the injured vertebra and traditional long segment instrumentation.Methods Between 2011 Dec and 2014 Dec, 104 patients with one level of thoracic-lumbar spine burst fractures were included in the study, of which 78 received the short segment pedicle screw instrumentation through the injured vertebra and the other 26 received the traditional long segment instrumentation. The surgical time, blood loss, the ratio of anterior height of injured vertebra, the local Cobb angle, the Visual Analog Scale (VAS) for back pain, Oswestry disability index (ODI) and complications were assessed.Result All patients obtained the entire complete followed up for 6~36 months, with an average of (19.8±7.4) months. The surgical time and blood loss were greater in the traditional long segment instrumentation group than short segment instrumentation group (allP<0.05). There were signiifcant differenceson ODI and VAS before surgery and at the ifnal visit in both groups (allP<0.05), but no signiifcant difference was detected between the two groups (allP>0.05). Both the ratio of anterior height of injured vertebra and the local Cobb angle improved after surgery immediately compared with before surgery (allP<0.05), and maintained at the final visit in both groups (allP>0.05). No significant difference was detected between the two groups at different time points (allP>0.05). No screw was broken or loosing observed in both groups.Conclusion Outcomes of short segment pedicle screw instrumentation through the injured vertebra are similar to the traditional long segment instrumentation, with a less blood loss and surgical time.
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