胸腰椎爆裂性骨折体位复位的效果及影响因素研究  

Study on effect and influence factors of postural reduction for thoracolumbar burst fracture

作　　者：张正平[1] 杨辉 章雪芳 李辉[1] 刘团江[1] 赵勤鹏[1] 黄琳红[1] 曹子君[1] 何立民[1] 郝定均[1] ZHANG Zheng-ping;YANG Hui;ZHANG Xue-fang;LI Hui;LIU Tuan-jiang;ZHAO Qin-peng;HUANG Lin-hong;CAO Zi-jun;HE Li-min;HAO Ding-jun(Affiliated Red Cross Hospital of Medical College of Xi＇ an Jiaotong University,Xi＇ an Shaanxi 710054,China;Hu Yi District people＇ s hospital,Xi＇ an Shaanxi 710300,China)

机构地区：[1]西安交通大学医学院附属红会医院,西安710054 [2]鄠邑区人民医院,陕西西安710300

出　　处：《局解手术学杂志》2018年第7期477-481,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：陕西省社会发展科技攻关项目(2016SF-221)

摘　　要：目的探讨胸腰椎爆裂性骨折后入路术前体位复位的效果以及影响因素。方法回顾性分析2013年8月至2016年2月收治的144例胸腰椎(T11~L2)爆裂性骨折伴脊柱畸形后型体位复位患者的临床资料,收集性别、年龄、体质指数以及临床和影像学资料。比较复位前后病例的Cobb氏角以椎体压缩的变化,利用单因素分析和多元logistics回归分析明确体位复位不完全的影响因素。结果体位复位的病例Cobb氏角与未复位相比差异无统计学意义(P>0.05),椎体前缘压缩率由(0.43±0.12)%下降为(0.27±0.09)%,椎体后缘压缩率由(0.1±0.06)%下降为(0.07±0.03)%,差异有统计学意义(P<0.05)。术前椎体压缩率为显著的影响因素,其优势比(OR)值分别为4.58[95%CI(1.42,20.15)]和2.31[95%CI(1.09,21.83)](P<0.05)。结论体位复位对于胸腰椎爆裂性骨折具有明显的治疗作用,但术前椎体压缩率过大会导致治疗效果不佳。Objective To explore the effect and influence factors of postural reduction in posterior approach surgery for thoraeolumbar burst fracture. Methods A retrospective analysis was performed on 144 patients with thoracolumbar（TH - L2 ） burst fi＇actures with spinal deformity , who were admitted from August 2013 to February 2016 and treated with posterior postural reduction, so as to collect their gender, age, body mass index（BMI） and clinical and imaging data. By comparing the difference of cases in Cobb＇ s angle and vertebral compression before and after postural reduction, the influence factors of incomplete postural reduction were determined through univariate analysis and multivariate logistics regression analysis. Results Differences in the Cobb＇ s angle between the cases with postural reduction and without postural reduction were not statistically significant（ P 〉 0.05 ）. The compression rate of vertebral anterior edge was decreased from（ 0.43 ± 0.12 ） % to （ 0.27 ± 0.09 ） %, that of vertebral posterior edge was decreased from（ 0.1 ± 0.06 ） % to （ 0.07 ± 0.03 ） %, and the difference between them was statistically significant（ P 〈 0.05 ）. The preoperative compression rate of vertebral body was a significant influence factor, and the odds ratio（OR） was4.58 [95%CI（1.42,20.15）] and 2. 31[95% CI（1. 09, 21.83）1（P〈0.05） respectively. Conclusion Postural reduction has obvious therapeutic effect on thoracolumbar burst fractures, but large preoperative compression rate of vertebral body may contribute to poor therapeutic effect.

关 键 词：胸腰椎 爆裂性骨折 骨折复位术 体位复位 

分 类 号：R687.3[医药卫生—骨科学]