摘要
背景:跨伤椎螺钉置入固定容易出现椎体骨小梁不能完全恢复,影响脊柱矢状位力学稳定。经伤椎短节段固定的抗屈力、抗扭转力明显增加,增加了椎体在屈曲、后伸、旋转等各种活动的承载负荷,可更好地维持伤椎稳定性,为骨折愈合创造有利条件。目的:对比经伤椎和跨伤椎置钉固定治疗胸腰椎骨折的早中期随访结果。方法:选择2017年4月至2018年4月青海大学附属医院收治的88例胸腰段椎骨折患者,根据固定方案分为跨伤椎组、经伤椎组。所有患者对治疗方案均知情同意,且得到医院伦理委员会批准。统计分析2组患者术中出血量、手术时间、术后患者卧床时间及术后手术部位感染、皮下血肿发生情况,对比2组术前及术后6,12个月随访的疼痛目测类比评分、Oswestry功能障碍指数、伤椎椎体前缘高度比及后凸Cobb角。结果与结论:①经伤椎组患者手术时间长于跨伤椎组、术中出血量大于跨伤椎组,但术后卧床时间比跨伤椎组短,差异有显著性意义(P<0.05);②术前及术后2周随访:2组目测类比评分、Oswestry功能障碍指数、伤椎椎体前缘高度比、后凸Cobb角差异无显著性意义(P>0.05);③术后6,12个月随访:经伤椎组目测类比评分、Oswestry功能障碍指数低于跨伤椎组,伤椎椎体前缘高度比大于跨伤椎组,后凸Cobb角小于跨伤椎组,2组间比较差异均有显著性意义(P<0.05);④跨伤椎组术后12个月并发症发生率(30%)高于经伤椎组(7%),差异有显著性意义(P=0.001);⑤提示经伤椎椎弓根螺钉固定治疗胸腰椎骨折不仅能有效恢复和维持伤椎高度及后凸Cobb角,恢复椎体的生理高度及曲度,而且术后并发症发生率低,可以有效改善患者预后,提高生活质量。
BACKGROUND:The bone trabecula of the vertebral body cannot be fully recovered,and the mechanical stability of the sagittal position of the spinal column is affected.The anti-bending force and the anti-torsion force of the short-segment fixation of fractured vertebra are obviously increased.The bearing load of various activities such as flexion,extension,and rotation of the vertebral body is increased.The stability of the injured vertebra is better maintained,and favorable conditions are created for fracture healing.OBJECTIVE:To compare the early-and mid-term follow-up results of trans-injured and cross-injured vertebra pedicle screw fixation in the treatment of thoracolumbar fractures.METHODS:Eighty-eight patients with thoracolumbar vertebrae fracture treated in Affiliated Hospital of Qinghai University from April 2017 to April 2018 were divided into trans-injured vertebra group and cross-injured vertebra group according to the treatment plan.All patients signed the informed consent.This study was approved by the Hospital Ethics Committee.Intraoperative blood loss,operation time,postoperative bed rest time,postoperative site infection,and subcutaneous hematoma were analyzed in both groups.Visual analogue scale score,Oswestry Disability Index,anterior edge height ratio and kyphosis Cobb angle were compared before surgery,6 and 12 months after surgery between the two groups.RESULTS AND CONCLUSION:(1)The operation time was longer and intraoperative blood loss was higher in the trans-injured group than those in the cross-injured group,but the postoperative bed rest time was shorter in the trans-injured group than that in the cross-injured group(P<0.05).(2)There was no significant difference in visual analogue scale score,Oswestry Disability Index,anterior edge height ratio and kyphosis Cobb angle between the two groups preoperatively and 2 weeks after the operation(P>0.05).(3)At 6 and 12 months after surgery,visual analogue scale score and Oswestry Disability Index were lower in the trans-injured group than in the cross-injured group;anterior edge height ratio was larger in the trans-injured group than in the cross-injured group;kyphosis Cobb angle was smaller in the trans-injured group than in the cross-injured group(all P<0.05).(4)Incidence of complications was higher in the cross-injured group(30%)than in the trans-injured group(7%)(P=0.001).(5)The treatment of thoracolumbar fracture with trans-injured pedicle screw can not only effectively restore and maintain the injured vertebral height and kyphosis Cobb angle,restore the physiological height and curvature of vertebral body,but also the incidence of postoperative complications is low,which can effectively improve the prognosis of patients and improve the quality of life of patients.
作者
许勇
官众
李永霞
陈锋
任磊
Xu Yong;Guan Zhong;Li Yongxia;Chen Feng;Ren Lei(Department of Spinal Surgery of Affiliated Hospital of Qinghai University,Xining 810000,Qinghai Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2020年第12期1823-1828,共6页
Chinese Journal of Tissue Engineering Research
关键词
胸腰椎骨折
椎弓根螺钉
置钉
内固定
伤椎高度
后凸Cobb角
并发症
thoracolumbar fracture
pedicle screw
screw placement
internal fixation
injured vertebrae height
kyphosis Cobb angle
complications
