赵锐 郑志巍 刘军 程扬 单军

【摘要】 目的：通過比较经椎间孔椎体间植骨（TLIF）或单纯后外侧植骨（PLF）结合椎弓根螺钉内固定治疗单节段胸腰椎爆裂性骨折的临床疗效，以指导临床上治疗方案的选择。方法：回顾性分析本院2017年6月-2019年1月收治的58例单节段胸腰段爆裂性骨折患者临床资料，按照手术方式将其分为TLIF组（A组）31例和PLF组（B组）27例。比较两组手术时间，术中出血量，术后引流量，术前、术后1周、术后1年时伤椎前缘高度比以及Cobb角。结果：B组手术时间短于A组，术中出血量少于A组（P<0.05），A组术后引流量多于B组，差异有统计学意义（P<0.05）。术前及术后1周，两组前缘高度比、Cobb角比较，差异均无统计学意义（P>0.05）;术后1年，A组前缘高度比大于B组（P<0.05），Cobb角小于B组（P<0.05）。A组前缘高度丢失率、Cobb角变化均小于B组（P<0.05）。A组30例存在骨性融合，融合率96.8%;B组19例存在骨性融合，融合率70.4%。结论：对于应用椎弓根钉棒系统治疗单节段胸腰段爆裂性骨折，TLIF与PLF相比，能通过一次手术恢复脊柱三柱稳定性，对于防止术后伤椎椎体前缘高度丢失及Cobb角丢失有明显优势，并且拥有更高的植骨融合率，值得临床推广。

【关键词】 爆裂性骨折 椎弓根螺钉 经椎间孔椎体间融合

Comparison of Treatment Outcome between Transforaminal Lumbar Interbody Fusion and Posterolateral Fusion in Thoracolumbar Burst Fractures/ZHAO Rui， ZHENG Zhiwei， LIU Jun， CHENG Yang， SHAN Jun. //Medical Innovation of China， 2021， 18（07）： -130

[Abstract] Objective： To compare the clinical efficacy of transforaminal lumbar interbody fusion （TLIF） or posterolateral fusion （PLF） combined with pedicle screw internal fixation in the treatment of single-level thoracolumbar burst fractures， and to guide the selection of clinical treatment options. Method： The clinical data of 58 patients with single-level thoracolumbar burst fractures admitted to our hospital from June 2017 to January 2019 were retrospectively analyzed， and they were divided into TLIF group （group A） of 31 cases and PLF group （group B） of 27 cases according to the surgical methods. The operative time， intraoperative blood loss， postoperative drainage volume， the ratio of anterior edge height of injured vertebra and Cobb angle before operation， 1 week after operation and 1 year after operation were compared between the two groups. Result： The operative time of group B was shorter than that of group A， the intraoperative blood loss was less than that of group A （P<0.05）， and the postoperative drainage volume of group A was more than that of group B， the differences were statistically significant （P<0.05）. Before and 1 week after surgery， there were no significant differences in the ratio of front edge height and Cobb angle between the two groups （P>0.05）. One year after operation， the ratio of the leading edge height in group A was higher than that in group B （P<0.05）， and the Cobb angle was lower than that in group B （P<0.05）. The changes of leading edge height loss rate and Cobb angle in group A were lower than those in group B （P<0.05）. 30 cases with bony fusion in group A， and the fusion rate was 96.8%. 19 cases with bony fusion was found in group B， and the fusion rate was 70.4%. Conclusion： For the application of pedicle screw and rod system in the treatment of single-level thoracolumbar burst fractures， compared with PLF， TLIF can restore the stability of the three columns of the spine through a single operation， which has obvious advantages in preventing the loss of the anterior edge of the vertebral body and the loss of Cobb angle after postoperative injury， and has a higher rate of bone graft fusion， which is worth clinical promotion.

[Key words] Burst fracture Pedicle screw Transforaminal lumbar interbody fusion

First-authors address： Shenyang Orthopedic Hospital， Shenyang 110044， China

doi：10.3969/j.issn.1674-4985.2021.07.030

胸腰段（T11～L2）骨折为临床常见疾病，由于其具有解剖学上、生物力学上的特殊性，所以胸腰段为脊柱骨折的好发部位，爆裂性骨折累及脊柱前、中柱，造成了脊柱的不稳定，同时椎体后缘移位的骨块易进入椎管，对脊髓或马尾神经造成压迫，而导致严重的神经症状，甚至瘫痪，为患者及其家庭带来巨大的负担，因此胸腰段爆裂性骨折的治疗十分重要，目前胸腰段骨折的治疗已取得很大进展，目前后入路经椎弓根钉内固定治疗胸腰段骨折由于其创伤小，易于操作，以及提供的可靠的内固定效果，已成为临床上的主要治疗方式，取得了良好的临床治疗效果。但单纯椎弓根螺钉内固定，存在术后矫正度易丢失、内固定装置疲劳断裂，甚至会发生迟发性后凸畸形等问题。任何坚强的内固定都不能替代脊柱的骨性融合所提供的永久稳定性，所以在椎弓根螺钉内固定的同时行植骨融合已是脊柱外科医生的共识。……