目的 比较后路短节段经伤椎置钉术中采用悬臂梁复位法与反弓折顶复位法对Denis B型胸腰段骨折伤椎高度恢复的差异.方法 2017年1月—2019年6月,廊坊市第四人民医院和霸州市第三医院采用后路短节段经伤椎置钉治疗Denis B型胸腰段骨折(T11～L2)患者43例,其中术中应用悬臂梁复位法20例(A组),应用反弓折顶复位法23例(B组).观察并记录2组患者术中出血量,术后切口愈合和感染情况及内固定相关并发症发生情况.测量并计算术前和术后3 d伤椎前缘、中部、后缘压缩率和Cobb角,评价伤椎复位情况.采用美国脊髓损伤协会(ASIA)分级评价患者神经功能恢复情况.结果 所有手术顺利完成.所有患者随访6～18个月,平均10个月.A组术中出血量少于B组,差异有统计学意义(P<0.05).A组术后Cobb角、伤椎前缘和后缘压缩率均小于B组,差异均有统计学意义(P<0.05).A组2例和B组3例术前ASIA D级患者,术后1个月神经功能均恢复正常.2组均未发生内固定相关并发症.A组1例术后切口愈合不良,换药后愈合.结论 悬臂梁复位法恢复伤椎前缘、后缘高度优于反弓折顶复位法,且术中操作简单易行、术中出血量少.

BACKGROUND:Due to different pathogenesis of degenerative and isthmic lumbar spondylolisthesis, the differences in sagittal spino-pelvic morphology and life quality between them are stil unclear. <br> OBJECTIVE:To investigate the differences in sagittal spino-pelvic morphology and life quality between degenerative and adult isthmic lumbar spondylolisis patients. <br> METHODS:From May 2012 to February 2015, 169 lumbar spondylolisthesis patients with complete imaging data were included in the study. Degenerative group contained 83 patients, and isthmic group contained 86 patients. The folowing radiographical parameters were measured on standard standing lateral radiographs of the entire spine, including thoracic kyphosis, lumbar lordosis, sagittal vertical axis, pelvic incidence, pelvic tilt and sacral slope. Meanwhile, slippage angle, slippage percentage and slippage distance ofal patients were also measured. SF-36 scale was employed to evaluate life quality, which was compared between groups. <br> RESULTS AND CONCLUSION:(1)Lumbar lordosis, thoracic kyphosis and slippage angle were significantly lower in the degenerative group than those in the isthmic group (P< 0.05-0.01). The sagittal vertical axis in degenerative group was higher than that in isthmic group (P< 0.01). (2) With respect to the domains of SF-36 scale, degenerative group had lower physical functioning score and social functioning score compared with the isthmic group (P< 0.01). (3) Pelvic incidence, pelvic tilt, sacral slope, slippage percentage and slippage distance showed no significant difference between two groups (P> 0.05). (4) Results suggested that pelvicmorphology between the degenerative and isthmic lumbar spondylolisthesis was similar. Compared with degenerative lumbar spondylolisthesis, isthmic spondylolisthesis patients have higher thoracic kyphosis, lumbar lordosis and slippage angle. In addition, notable limitations of physical functioning and social functioning were found in degenerative lumbar spondylolisthesis patients.