“三位一体”程序化模式治疗稳定胸腰段脊柱爆裂骨折的疗效分析  

Analysis of curative effect of “trinity” programmed mode in treatment of stable thoracolumbar burst fractures

作　　者：贺志亮 王德成 陈学谦 何稚鸥 石浩 杨彬 汪振国 张高翔 HE Zhi-liang;WANG De-cheng;CHEN Xue-qian;HE Zhi-ou;SHI Hao;YANG Bin;WANG Zheng-guo;ZHANG Gao-xiang(Department of Spinal Trauma,Beijing Tongzhou District Hospital of Integrated Traditional Chinese and Western Medicine,Beijing 100102,China)

机构地区：[1]北京市通州区中西医结合医院脊柱创伤科,北京100102

出　　处：《中国骨与关节损伤杂志》2021年第1期9-12,共4页Chinese Journal of Bone and Joint Injury

基　　金：北京中医药科技资助项目(JJ2014-05)。

摘　　要：目的比较"三位一体"程序化模式与单纯腰椎后路椎弓根钉撑开内固定术治疗稳定胸腰段脊柱爆裂骨折的临床疗效。方法回顾性分析自2015-06—2018-06诊治的58例稳定胸腰段爆裂骨折,30例采用"三位一体"程序化模式治疗(观察组),28例单纯采用腰椎后路椎弓根钉撑开内固定术治疗(对照组),比较2组术后3周、术后6个月、术后15个月ODI指数、椎体前缘高度比值、伤椎Cobb角、椎管占位率,比较2组术后并发症情况以及末次随访时的疗效。结果 58例均顺利完成手术并获得至少15个月的随访。观察组并发症情况明显优于对照组,差异有统计学意义(P<0.05)。观察组术后6个月以及术后15个月ODI指数低于对照组,差异有统计学意义(P<0.05),2组术后3周ODI指数比较差异无统计学意义(P>0.05);观察组术后3周、术后6个月、术后15个月椎体前缘高度比值大于对照组,伤椎Cobb角与椎管占位率小于对照组,差异有统计学意义(P<0.05)。末次随访时观察疗效优于对照组,差异有统计学意义(P<0.05)。结论 "三位一体"程序化模式治疗稳定胸腰段爆裂骨折在恢复伤椎高度,改善胸腰椎后凸畸形、改善腰椎功能活动方面优于单纯采用腰椎后路椎弓根钉撑开内固定术治疗。Objective To compare the clinical efficacy of the"trinity"programmed model and the simple posterior lumbar pedicle screw distraction and internal fixation in the treatment of stable thoracolumbar burst fractures.Methods A retrospective analysis of 58 cases of stable thoracolumbar burst fractures from June 2015 to June 2018 was conducted.Thirty cases were treated with the"trinity"programmed mode(observation group)while 28 cases were treated solely with posterior lumbar pedicle screw support treatment with internal fixation(control group).The ODI index,anterior vertebral height ratio,Cobb angle of injured vertebrae,the spinal canal occupancy rate at 3 weeks,6 months,and 15 months after operation,and the postoperative complications and the efficacy at the last follow-up were compared between the two groups.Results All operations of the 58 cases"were completed successfully and followed up for at least 15 months.The complications of the observation group"were significantly better than those of the control group,and the difference"was statistically significant(P<0.05).The ODI index of the observation group"was lower than that of the control group at 6 months and 15 months after the operation,the difference"was statistically significant(P<0.05),but not statistically significant at 3"weeks after the operation(P>0.05).The ratio of the height of the anterior edge of the vertebral body in the observation group"was greater and the Cobb angle of injured vertebrae and spinal canal occupancy rate"were lower than those of the control group at 3"weeks,6 months,and 15 months after the operation,the difference"was statistically significant(P<0.05).At the last follow-up,the effect of the observation group was better than that of the control group,with statistically significant difference(P<0.05).Conclusion The treatment of stable thoracolumbar burst fractures with"trinity"is better than the simple pedicle screw distraction internal fixation in restoring thoracolumbar vertebrae height,improving thoracolumbar kyphosis and improving lu

关 键 词：稳定胸腰段脊柱爆裂骨折 手法复位 内固定 功能锻炼 腰椎后路椎弓根钉撑开内固定术 

分 类 号：R687.3[医药卫生—骨科学]