经伤椎椎弓根5钉或6钉强化内固定与跨伤椎椎弓根4钉内固定治疗胸腰椎骨折脊柱稳定性比较  

Spinal stability of intervertebral grafting reinforced by five or six augmenting screws versus transvertebral grafting reinforced by four augmenting screws for thoracolumbar vertebral fractures

作　　者：周宇 刘跃洪 刘树平 陈曦 覃炜 李其凤 Zhou Yu;Liu Yuehong;Liu Shuping;Chen Xi;Qin Wei;Li Qifeng(Department of Orthopedics,Deyang Hospital Affiliated to Chengdu Medical College,Deyang Clinical Medical School(People's Hospital of Deyang City),Deyang 618000,Sichuan Province,China)

机构地区：[1]成都医学院附属德阳医院.德阳临床医学院(德阳市人民医院)骨科,四川省德阳市618000

出　　处：《中国组织工程研究》2019年第4期505-511,共7页Chinese Journal of Tissue Engineering Research

基　　金：四川省卫生和计划生育委员会科研项目(17PJ213);项目负责人:覃炜;四川省卫生和计划生育委员会科研项目(17ZD023);项目负责人:刘跃洪;四川省卫生和计划生育委员会科研项目(17PJ408);项目负责人:李其凤~~

摘　　要：背景:传统跨伤椎固定治疗后易出现骨折复位再丢失、断钉断棒等并发症,经伤椎置钉固定技术可获得良好的临床疗效,但其中长期效果还需要大量临床资料证实。目的:比较经伤椎椎弓根5钉或6钉加强内固定与跨伤椎椎弓根4钉内固定治疗胸腰椎单节段椎体骨折的稳定性。方法:将56例胸腰椎单节段椎体骨折患者按照是否行伤椎置钉分为经伤椎组29例和跨伤椎组27例。经伤椎组患者给予经皮伤椎椎弓根5钉或6钉加强内固定方案,跨伤椎组患者给予跨伤椎4钉经皮椎弓根内固定方案。比较2组患者的手术时间、术中出血量、住院时间,以及术后椎体前缘高度变化、后凸矫正程度、疼痛和日常生活功能改善情况。结果与结论:(1)所有患者均获得3年以上随访;(2)经伤椎组的手术时间长于跨伤椎组(P <0.05);(3)治疗后1周、3个月和末次随访时2组患者椎体高度得到恢复,后凸畸形得到明显改善。末次随访经伤椎组椎体压缩程度及矢状面Cobb角矫正度丢失程度均优于跨伤椎组,差异有显著性意义(P <0.05);(4)治疗后2组患者的腰痛症状、日常生活功能均得到明显缓解,在随访结束时经伤椎组目测类比评分、Oswestry功能障碍指数均优于跨伤椎组(P <0.05);(5)随访期间2组均未出现神经根损伤、钉棒松动、断裂及脱落现象。跨伤椎组术后有1例患者发生邻近椎体骨折,经伤椎组未出现临近椎体骨折;(6)结果显示,经伤椎椎弓根加强内固定和跨伤椎椎弓根内固定均能较好地恢复胸腰椎骨折的椎体高度和Cobb角,但是前者可更加有效的重建脊柱生理序列并恢复其稳定性。BACKGROUND:Lost of reduction and broken nails usually occur following traditional transvertebral fixation.Intervertebral pedicle fixation can obtain satisfactory curative effectiveness,but its medium-and long-term outcomes still need to be testified by abundant clinical trials.OBJECTIVE:To compare the stability between intervertebral grafting reinforced by five or six augmenting screws and transvertebral grafting reinforced by four augmenting screws in the treatment of single-segment thoracolumbar fractures.METHODS:Fifty-six patients with single-segment thoracolumbar fractures were divided into intervertebral fixation group(n=29,intervertebral grafting reinforced by five or six augmenting screws)and transvertebral fixation group(n=27,transvertebral grafting reinforced by four augmenting screws).The operation time,intraoperative blood loss,hospitalization time,anterior vertebral height,Cobb angle,pain degree and daily life function were compared between two groups.RESULTS AND CONCLUSION:(1)All patients were followed up for more than 3 years.(2)The operation time in the intervertebral fixation group was significantly longer than that in the transvertebral fixation group(P<0.05).(3)The anterior vertebral height and kyphosis at 1 week,3 months and last follow-up were significantly improved compared with the baseline.The degree of vertebral compression and loss of sagittal Cobb angle in the intervertebral fixation group were significantly superior to those in the transvertebral fixation group at the last follow-up(P<0.05).(4)The symptoms of low back pain and daily living function in the two groups were significantly relieved after surgery.The Visual Analogue Scale and Oswestry Disability Index scores in the intervertebral fixation group were significantly better than those in the transvertebral fixation group at the last follow-up(P<0.05).(5)During follow-up,no nerve root injury,or rod loosening,broking or dropping occurred.Only one case in the transvertebral fixation group suffered from adjacent vertebral fracture.(6

关 键 词：胸椎 腰椎 骨折 内固定器 组织工程 胸腰椎骨折 单节段椎体 经伤椎椎弓根内固定 跨伤椎椎弓根内固定 脊柱稳定性 

分 类 号：R459.9[医药卫生—治疗学]