摘要
[目的]探讨CT三维重建模拟经皮椎弓根置钉(percutaneous pedicle screw,PPS)内固定治疗胸腰椎骨折的临床疗效。[方法]回顾性收集本院2021年6月—2023年6月接受PPS内固定的85例胸腰椎骨折患者的临床资料。根据术前医患沟通结果,40例行CT三维重建模拟置钉(规划组),45例行常规置钉(常规组)。对比两组围手术期、随访与影像资料。[结果]所有患者均顺利完成手术,规划组手术时间[(84.5±16.4)min vs(98.2±20.3)min,P<0.001]、术中X线曝光次数[(6.1±2.3)次vs(10.4±3.0)次,P<0.001]、术中失血量[(48.3±5.2)mL vs(65.3±8.7)mL,P<0.001]、术后下地时间[(26.4±2.8)d vs(28.0±3.4)d,P=0.021]均显著小于常规组,置钉位置[优/良/可/差,(200/20/10/0)vs(186/30/29/0),P<0.001]及一次置钉成功率(95.0%vs 80.0%,P=0.040)均显著优于常规组。随访时间平均(15.5±2.0)个月,两组完全负重活动时间的差异无统计学意义(P>0.05)。随时间推移,两组术后VAS与ODI评分均明显减少(P<0.05),规划组术后1周VAS评分[(4.0±0.6)vs(4.3±0.7),P=0.038]、术后3个月ODI评分[(22.4±6.0)vs(25.0±5.7),P=0.044]均显著优于常规组。影像方面,随时间推移,两组伤椎前缘与后缘高度均显著增加(P<0.05)、局部Cobb角显著降低(P<0.05),相应时间点两组上述指标的差异无统计学意义(P>0.05)。[结论]CT三维重建模拟PPS内固定能缩短手术时间,减少X线曝光次数,置钉效果良好,有利于患者术后早期功能恢复。
[Objective]To investigate the clinical efficacy of 3D CT reconstruction for simulation before percutaneous pedicle screw(PPS)fixation in the treatment of thoracolumbar fractures.[Methods]A retrospective study was conducted on 85 patients who had thoraco-lumbar fractures fixed with PPS in our hospital from June 2021 to June 2023.According to the preoperative doctor-patient communication,40 patients received CT 3D reconstruction for simulation before PPS(planning group),while other 45 patients had routine PPS performed without preoperative 3D reconstruction for simulation(routine group).The perioperative,follow-up and imaging data of the two groups were compared.[Results]All patients in both group were successfully operated on.The planning group proved significantly superior to the routine group in terms of operation time[(84.5±16.4)min vs(98.2±20.3)min,P<0.001],intraoperative X-ray exposure times[(6.1±2.3)times vs(10.4±3.0)times,P<0.001],intraoperative blood loss[(48.3±5.2)mL vs(65.3±8.7)mL,P<0.001],postoperative ambulation time[(26.4±2.8)days vs(28.0±3.4)days,P=0.021],the screw placement position[excellent/good/fair/poor,(200/20/10/0)vs(186/30/29/0),P<0.001]and the success rate of first screw placement(95.0%vs 80.0%,P=0.040).The average follow-up time was(15.5±2.0)months,and there was no significant difference in time to resume full weight-bearing activity between the two groups(P>0.05).The VAS and ODI scores were significantly decreased in both groups over time(P<0.05).The planning group was significantly better than the routine group regarding VAS score 1 week after surgery[(4.0±0.6)vs(4.3±0.7),P=0.038]and ODI score 3 months postoperatively[(22.4±6.0)vs(25.0±5.7),P=0.044].With respect of imaging,the anterior and posterior heights of fractured vertebrae were significantly increased(P<0.05),while the local kyphosis was significantly decreased in both group postoperatively compared with those preoperatively(P<0.05),which were not statistically significant between the two groups at any corresponding time points(P>0.05).[Conclusion]CT 3D reconstruction for simulation before PPS fixation of thoracolumbar fractures with advantages of shortening the operation time,reducing the number of X-ray exposure,and achieving better screw placement accuracy,is conducive to the early functional recovery of the patients.
作者
陈壮军
黎尊成
李小玲
郑庆中
CHEN Zhuang-jun;LI Zun-cheng;LI Xiao-ling;ZHENG Qing-zhong(Hainan Western Central Hospital,Danzhou 571700,Hainan,China)
出处
《中国矫形外科杂志》
北大核心
2025年第20期1862-1867,共6页
Orthopedic Journal of China
关键词
胸腰椎骨折
CT三维重建
经皮椎弓根置钉
内固定
thoracolumbar fracture
CT 3D reconstruction
percutaneous pedicle screw
internal fixation
