摘要
目的：探讨胸腰段A型骨折术后支具佩戴时间对疗效的影响。方法：2008年1月~2012年12月收治并获得随访的单节段胸腰段（T11~L2）A型骨折患者66例,均采用单纯Schanz螺钉固定的术式,术后第2天开始佩戴胸腰支具。根据术后支具佩戴时间分为A组和B组：A组患者32例,支具佩戴时间〈1个月;B组34例,佩戴支具时间〉1个月且〈3个月。术前伤椎后凸Cobb角A组为22.1°±4.9°,B组为21.9°±5.4°;术前椎体压缩率A组为（31.8±6.8）%,B组为（32.6±6.5）%。两组患者的年龄、性别、骨折节段、术前后凸Cobb角和术前椎体压缩率均无统计学差异（P≥0.05）。测量术后及术后1年时的伤椎后凸Cobb角,计算术后1年时的后凸Cobb角丢失率。术后1年时进行腰痛的视觉模拟疼痛评分（VAS）、JOA评分、Oswestry功能障碍指数（Oswestry disability index,ODI）及总体生活质量评分。结果 ：两组术后均未出现并发症。术后伤椎后凸Cobb角A组为7.2°±2.9°,B组为7.2°±2.9°;术后1年Cobb角A组为8.1°±2.8°,B组为8.4°±3.2°;Cobb角丢失率A组为（14.4±20.2）%,B组为（19.6±23.5）%;两组比较均无统计学差异（P≥0.05）。术后椎体压缩率A组为（15.3±3.7）%,B组为（15.8±3.9）%;术后1年椎体压缩率A组为（16.8±4.0）%,B组为（17.1±3.8）%;两组比较均无统计学差异（P≥0.05）。术后1年VAS评分A组为1.03±0.56分,B组为1.18±0.68分;术后1年ODI A组为（9.9±3.3）%,B组为（11.3±3.4）%;两组比较均无统计学差异（P≥0.05）。术后1年患者生活质量评分A组为2.6±0.5分,B组为2.1±0.7分,两组比较有统计学差异（P〈0.05）。术后1年JOA评分A组为25.3±1.2分,B组为24.4±1.5分,两组比较有统计学差异（P〈0.05）。术后3个月随访A组患者骨性愈合29例（90.6%）,B组31例（91.2%）,两组骨性愈合率比较无统计学差异（P≥0.05）;术后1年随访两组患者均骨性愈合,且无内固定失败。结论：对于单节段胸腰段A型骨折患者,术后长时间（〉1个月）佩戴支具与较短时间（〈1个月）佩戴支具的临床疗效无明显差异,较短时间佩戴支具患者术后生活质量评分和JOA评分更高。
Objectives： To discuss the effect of bracing time on the outcome in the post-operative patients who have type A thoracolumbar fracture. Methods： A retrospective analysis was performed on sixty-six pa- tients with single-level type A thoracolumbar fracture from January 2008 to December 2012. Schanz pedicle screws were used in all patients and all of them wore thoracolumbosacral orthosis （TLSO） from 1 day after operation. These patients were divided into two groups according to time of bracing： 32 patients wearing TL- SO for less than 1 month after operation were classified as group A, while the other 34 patients wearing TL- SO for more than 1 month were classified as group B. The pre-operative Cobb angle was 22.1°±4.9° in group A and 21.9°＋5.4° in group B, compression ratio of vertebrae before operation was （31.8±6.8）% in group A and （32.6-＋6.5）% in group B. There was no statistical difference with respect to the age, gender, fracture segment, pro-operative Cobb angle or pre-operative compression ratio of vertebrae（P≥0.05）. The Cobb angles immediately after operation and at 1 year after operation were measured. One year after operation, all patients were asked to finish a series of evaluation, which included visual analogue seale（VAS）, JOA score, Oswestry disability index（ODI） and general life quality. Results： No post-operative complications were noted in both groups. The Cobb angle immediately after operation was 7.20±2.9° in both group A and group B. The Cobb angle at 1 year after operation was 8.1°±2.8° in group A and 8.4o±3.2° in group B, with the loss rate of Cobb angle of （14.4±20.2）% in group A and （19.6±23.5）% in group B. There was no statistical difference between 2 groups（P≥0.05）. The compression ratio of vertebrae immediately after operation was （15.3±3.7）% in group A and （15.8%±3.9）% in group B. The compression ratio of vertebrae at 1 year after operation was （16.8±4.0）% in group A and （17.1%±3.8）% in group B. There was no statistical difference between group A and B（P≥0.05）. The VAS score at 1 year after operation was 1.03±0.56 in group A and 1.18±0.68 in group B. The ODI at 1 year after operation was （9.9±3.3）% in group A and （11.3±3.4）% in group B. There was no statistical difference between group A and B（P≥0.05）. The score of general life quality at 1 year after operation was 2.6±0.5 in group A and 2.1±0.7 in group B, and there was statistical difference between group A and B（P〈0.05）. The JOA score at 1 year after operation was 25.3±1.2 in group A and 24.4±1.5 in group B, and there was statistical difference between group A and B （P〈0.05）. The bony union was noted in 29 eases of group A（90.6%） and 31 cases in group B（91.2%） at 3 months after operation, there was no statistical dif- ference between 2 groups（P≥0.05）. All fractures healed at 1 year after operation and there was no instrument failure. Corlehmions： For the post-operative patients with single segmental type A thoracolumbar fracture, long time（more than 1 month） and short time（less than 1 month） brace wearing show no difference on the outcome, but short time brace wearing has higher life quality score and JOA score.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2015年第2期143-147,共5页
Chinese Journal of Spine and Spinal Cord
关键词
胸腰段骨折
支具
佩戴时间
Thoracolumbar fracture
Orthosis
Time of bracing
