两种微创椎弓根螺钉系统治疗胸腰椎骨折的比较研究  

Comparison of uni-axial （Can-Help） and poly-axial （Sextant） screwing systems for thoracolumbar fractures

作　　者：黄文君[1] 何登伟[1] 李方财[2] 朱烨[1] 俞伟杨[1] 刘飞俊[1] 

机构地区：[1]丽水市中心医院骨科, 温州医科大学附属第五医院,323000 [2]浙江大学医学院附属第二医院骨科

出　　处：《中华创伤骨科杂志》2014年第6期470-474,共5页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金（30970702、81271663）,浙江省公益技术应用研究项目（2011C33026）

摘　　要：目的 比较两种微创椎弓根螺钉系统治疗胸腰椎骨折的临床疗效.方法 2010年3月至2012年6月共有42例无神经损伤症状的胸腰椎骨折患者采用微创复位内固定手术治疗,其中Can-Help微创椎弓根螺钉系统治疗（Can-Help组）22例,Sextant微创椎弓根螺钉系统治疗（Sextant组）20例.两组患者术前一般资料比较差异无统计学意义（P＜0.05）,具有可比性.记录并比较两组患者的围手术期相关指标、cobb角、视觉模拟评分（VAS）及Oswestry功能障碍指数（ODI）.结果 所有患者术后获18～26个月（平均21.1个月）随访.与Sextant组比较,Can-Help组患者的手术时间、术中X线暴露时间更短,术中出血量更少,差异均有统计学意义（P＜0.05）.所有患者术后1周、3、6、12、18个月的cobb角、VAS评分和ODI指数均较术前明显改善,差异有统计学意义（P＜0.05）.术后Can-Help组患者的cobb角较Sextant组小,差异有统计学意义（P＜0.05）.与Sextant组比较,Can-Help组患者的术后3、6、12、18个月的cobb角、VAS评分和ODI指数均改善更好,差异有统计学意义（P＜0.05）.两组患者术中均未发生神经损伤,围手术期未发现重大并发症,无伤口感染、内固定松动、断裂发生.结论 与多轴设计的Sextant系统比较,采用单轴设计的Can-Help系统治疗无神经损伤的胸腰椎骨折,缩短了手术时间和术中X线暴露时间,且具有良好的矫正后凸畸形能力和预防矫正丢失能力,是一种更为理想的胸腰椎骨折微创内固定系统.Objective To compare the curative effects of Can-Help uni-axial transpedicular screwing and Sextant poly-axial transpedicular screwing in the treatment of thoracolumbar fractures.Methods From March 2010 to June 2012,a total of 42 cases of unstable thoracolumbar fracture with no neurological deficit underwent minimally invasive reduction and internal fixation.Twenty-two patients were treated with Can-Help uni-axial transpedicular screwing and the other 20 ones with Sextant poly-axial transpedicular screwing.The two groups were compared in terms of perioperative indexes,cobb angle,visual analogue scale （VAS） and Oswestry disability index （ODI）.Results The patients were followed up for 18 to 26 （mean,21.1） months.Compared with the Sextant group,the Can-Help group had significantly shorter operation time,less intraoperative X-ray exposure and less blood loss （P 〈 0.05）.The cobb angle,VAS and ODI at one week,3,6,12 and 18 months postoperation were significantly improved in all the patients （P 〈 0.05）.The postoperative cobb angles in the Can-Help group were significantly smaller than those in the Sextant group （P 〈0.05）.The Can-Help group had significantly better improvements in cobb angle,VAS and ODI at 3,6,12 and 18 months postoperation than the Sextant group （P 〈 0.05）.None of the patients had neural injury.No intraoperative complications,wound infection,loosening or breakage of implants happened.Conclusion In the treatment of thoracolumbar fracture with no neurologic deficit,the uni-axial Can-Help transpedicular screwing may be preferable,compared with the poly-axial Sextant transpedicular screwing,because it can significantly reduce the operation time and intraoperative X-ray exposure,and has better performance in kyphosis correction and prevention of correction loss.

关 键 词：脊柱骨折 骨折固定术 内 外科手术 微创性 

分 类 号：R687.3[医药卫生—骨科学]