终板破裂对微创经皮椎弓根螺钉内固定治疗胸腰椎爆裂性骨折疗效影响的研究  

Impact of endplate fracture on clinical efficacy of minimally invasive percutaneous pedicle screwing for thoracolumbar vertebra burst fractures

作　　者：车荟 马成 李游[1] 赵峰[1] 任永信[1] Che Hui;Ma Cheng;Li You;Zhao Feng;Ren Yongxin(Department of Orthopaedics, The First Affiliated Hospital to Nanjing Medical University, Nanjing 210029, China)

机构地区：[1]南京医科大学第一附属医院骨科,210029

出　　处：《中华创伤骨科杂志》2018年第6期492-498,共7页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金（81572149）

摘　　要：目的探讨终板不同破裂程度对微创经皮椎弓根螺钉内固定治疗胸腰椎爆裂性骨折临床疗效的影响。方法回顾性分析2012年9月至2016年6月南京医科大学第一附属医院骨科应用微创经皮椎弓根螺钉内固定治疗的35例胸腰椎爆裂性骨折患者资料，根据终板破裂程度分为轻微组（17例）和严重组（18例）。记录并比较两组患者术前、出院前、术后6个月及末次随访时的伤椎矢状位cnhb角、伤椎高度压缩率、疼痛视觉模拟评分（VAS）、腰痛Oswestry功能障碍指数（ODI）及健康检查简表（SF-36）评分等。结果所有患者术后矢状位cobb角、伤椎高度压缩率、VAS、ODI及SF-36评分均较术前改善，差异有统计学意义（P〈0．05）。两组患者间术前、出院前、术后6个月、末次随访时伤椎矢状位cobb角比较差异均无统计学意义（P〉0．05）。末次随访时轻微组伤椎高度压缩率、VAS评分、ODI、SF-36评分均低于严重组，严重组患者末次随访时的伤椎高度压缩率、VAS评分、ODI、SF-36评分较术后6个月增加，差异均有统计学意义（P〈0．05）。结论终板破裂程度对于微创经皮椎弓根螺钉内固定治疗胸腰椎爆裂性骨折术后早期伤椎椎体高度的恢复无显著影响，但终板破裂严重者，后期可能出现伤椎椎体高度丢失，并影响患者的生活质量。Objective To investigate the impact of endplate fracture on the clinical efficacy of minimally invasive pereutaneous pedicle screwing for thoracolumbar burst fractures. Methods From September 2012 to June 2016, 35 patients with thoracolumbar burst fracture underwent minimally invasive percutaneous pedicle screwing at Department of Orthopaedics, The First Affiliated Hospital to Nanjing Medical University. They were divided into 2 groups according to the severity of endplate fracture： a mild fracture group of 17 cases and a severe fracture group of 18 cases. Their clinical data were recorded and compared between the 2 groups before surgery, before discharge, 6 months after surgery and at the last follow-up with respects to kyphosis cobb angle and height compression rate of the injured vertebra, and visual analogue scale （VAS）, Oswestry disability index （ODI） and the MOS 36-item Short Form Health Survey （SF-36） scores. Results The kyphosis cobb angle and height compression rate of the injured vertebra, and VAS, ODI and SF-36 scores before discharge, 6 months after surgery and at the last follow-up were all significantly improved in all the patients compared to the values before surgery （ P 〈 0.05） . There were no significant differences between the 2 groups in the kyphosis cobb angle of the injured vertebra before surgery, before discharge, 6 months after surgery or at the last follow-up （ P 〉 0.05） . At the last follow-up, the height compression rate of the injured vertebra, and VAS, ODI and SF-36 scores in the mild fracture group were significantly lower than in the severe fracture group （ P 〈 0. 05）, and the height compression rate of the injured vertebra, and VAS, ODI and SF-36 scores of the severe fracture group were significantly higher than the values 6 months before （ P 〈 0.05） . Conclusions The severity of endplate fracture may have no sig- nificant impact on the recovery of vertebral height in the early-to-mid stage after minimally invasive percutaneous pedicle screwin

关 键 词：胸椎 腰椎 骨折 终板破裂 经皮椎弓根螺钉内固定 

分 类 号：R687.3[医药卫生—骨科学]