Lyu Jianhua, Chen Kai, Tang Zhaohui, Chen Yu, Li Ming, Zhang Qiulin
Department of Orthopaedics, The 92 Hospital of the People's Liberation Army, Nanping, Fujian Province, China.
Department of Orthopaedics, Changhai Hospital, Second Military Medical University, Shanghai, China.
Int Orthop. 2016 Jun;40(6):1233-8. doi: 10.1007/s00264-016-3129-z. Epub 2016 Feb 24.
The aim of the study was to evaluate the efficacy of three different surgical procedures in the treatment of type A thoracolumbar fractures.
Between September 2012 and January 2015, a total of 90 patients with type A thoracolumbar fractures were randomly assigned into three groups of 30 each. Patients in group A, B, and C were treated with three-level percutaneous fixation, two-level percutaneous fixation, and three-level open fixation, respectively. Blood loss, duration of surgery, VAS scores, Cobb angles, and anterior height ratios of fractured vertebrae were collected for statistical analysis.
The average follow-up was 17.7 months. Post-operative Cobb angles were significantly corrected and anterior height ratios of fractured vertebrae were well restored in all three groups (p < 0.01). Back pain was efficiently relieved according to VAS score change (p < 0.01). There were significant differences in values of blood loss and post-operative VAS scores (at three months) between group A and group C (p < 0.01). No significant difference concerning post-operative anterior height ratios of fractured vertebrae, Cobb angles and correction losses was observed between group A and group B (p = 0.580, 0.840, 0.215, respectively).
Percutaneous fixation not only provides the same reduction effect as open fixation, but also has an advantage of causing less operation related trauma which is beneficial to post-operative rehabilitation. The efficacy of three-level percutaneous fixation and two-level percutaneous fixation in the treatment of type A thoracolumbar fractures is not significantly different.
本研究旨在评估三种不同手术方法治疗A型胸腰椎骨折的疗效。
2012年9月至2015年1月期间，共90例A型胸腰椎骨折患者被随机分为三组，每组30例。A组、B组和C组患者分别接受三级经皮固定、二级经皮固定和三级开放固定治疗。收集失血情况、手术时长、视觉模拟评分（VAS）、Cobb角以及骨折椎体的前缘高度比，进行统计分析。
平均随访17.7个月。所有三组术后Cobb角均得到显著矫正，骨折椎体的前缘高度比均得到良好恢复（p < 0.01）。根据VAS评分变化，背痛得到有效缓解（p < 0.01）。A组和C组之间的失血量和术后VAS评分（三个月时）值存在显著差异（p < 0.01）。A组和B组之间在骨折椎体术后前缘高度比、Cobb角和矫正丢失方面未观察到显著差异（分别为p = 0.580、0.840、0.215）。
经皮固定不仅能提供与开放固定相同的复位效果，还具有手术相关创伤较小的优势，这有利于术后康复。三级经皮固定和二级经皮固定治疗A型胸腰椎骨折的疗效无显著差异。
