过伸牵引弹性按压联合经皮椎弓根钉内固定治疗胸腰椎骨折的生物力学差异  

Biomechanical properties of hyperextension traction-elastic compression combined with percutaneous pedicle screw fixation for thoracolumbar fractures

作　　者：冯华龙 赖居易 黄飞强[1] 

机构地区：[1]广州中医药大学附属第四临床医学院,广东省深圳市518033

出　　处：《中国组织工程研究》2017年第23期3676-3681,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:治疗胸腰椎骨折的传统经皮椎弓根钉棒内固定在患者术后病椎的高度恢复等方面均存在许多不足,过伸牵引弹性按压联合经皮椎弓根钉内固定术在治疗胸腰椎骨折上提供了新的思路和方法。目的:观察和比较传统经皮椎弓根钉棒内固定术和过伸牵引弹性按压联合经皮椎弓根钉内固定术在治疗胸腰椎骨折上的生物力学差异。方法:回顾性病例分析40例单个椎体的单纯压缩性骨折患者,分别行传统经皮椎弓根螺钉固定术(对照组)和过伸牵引弹性按压联合经皮椎弓根钉内固定术治疗(治疗组)的病历资料,所有患者均无神经症状和体征。比较2组手术围手术期手术时间、术中放射量、术中失血量、住院时间、并发症;内固定前后各时间段伤椎矢状位Cobb’s角、椎体前缘高度百分比。以及使用目测来比评分法评价疼痛情况,Oswestry功能障碍指数量表评价患者症状改善情况。结果与结论:所有患者均获得随访,随访时间为12个月。(1)治疗组围手术期手术时间、术中放射量、术中失血量、住院时间、并发症和对照组比较差异无显著性意义(P>0.05);(2)两组内固定后伤椎矢状位Cobb’s角、椎体前缘高度百分比、目测类比评分及ODI评分显著优于内固定前(P<0.05);(3)治疗组内固定后24 h及6,12个月伤椎矢状位Cobb’s角、椎体前缘高度百分比均显著优于对照组(P<0.05);(4)治疗组术后12个月目测类比评分及Oswestry功能障碍指数评分显著优于对照组(P<0.05);(5)结果说明,过伸牵引弹性按压联合经皮椎弓根钉内固定在恢复椎体高度及疗效上比传统经皮椎弓根钉棒内固定更有优势。BACKGROUND： The traditional percutaneous pedicle screw fixation for thoracolumbar fractures has a lot of shortcomings, such as restoring the vertebral height. The combination of hyperextension traction-elastic compression and internal percutaneous pedicle screw fixation provides a new treatment strategy. OBJECTIVE： To observe and compare the biomechanical properties of the traditional peroutaneous transpedicular screw fixation and hyperextension traction-elastic compression combined with percutaneous pedicle screw fixation in the treatment of thoracolumbar fractures. METHODS： Clinical data of 40 patients with simple vertebral compression fractures undergoing traditional percutaneous pedicle screw fixation （control group） or hyperextension traction-elastic compression combined with percutaneous pedicle screw fixation （treatment group） were analyzed retrospectively, and none had neurologic signs or symptoms. The operation time, intraoperative radiant volume, intraoperative blood loss, hospitalization time or complications were compared between two groups. The sagittal Cobb angle and percentage of anterior height in vertebral body were measured at baseline and different time points after internal fixation. The pain and symptom improvement were evaluated by Visual Analogue Scale and Oswestry Disability Index. RESULTS AND CONCLUSION： All patients were followed up for 12 months. （1） There were no significant differences in the operation time, intraoperative radiation volume, intraoperative blood loss, hospitalization time and complications between two groups （P 〉 0.05）. （2） The sagittal Cobb angle, percentage of anterior height in vertebral body, Visual Analogue Scale and Oswestry Disability Index scores after internal fixation were significantly superior to those before internal fixation in both two groups （P 〈 0.05）. （3） The sagittal Cobb angle and percentage of anterior height in vertebral body in the treatment group were significantly superior to those in the control group at

关 键 词：骨科植入物 脊柱植入物 过伸牵引 弹性按压 经皮椎弓根钉 内固定 髓疆椎骨折 生物力学 

分 类 号：R318[医药卫生—生物医学工程]