经伤椎单双侧置钉及跨伤椎置钉对A1型胸腰椎骨折患者疗效及并发症的影响  

Effect of Single-and Bilateral-Injection and Trans-Injury Nail on the Curative Effect and Prognosis of A1 Thoracolumbar Fractures

作　　者：王立山 卢海波 钱浩 WANG Lishan;LU Haibo;QIAN Hao(Liaoyang Central Hospital, Liaoning Liaoyang 111000, China)

机构地区：[1]辽宁省辽阳市中心医院骨外科,辽宁辽阳111000

出　　处：《河北医学》2022年第2期271-277,共7页Hebei Medicine

基　　金：辽宁省自然科学基金项目,(编号:201904047)。

摘　　要：目的:探究经伤椎单、双侧置钉及跨伤椎置钉对A1型胸腰椎骨折患者疗效及并发症的影响。方法:选取2019年5月至2020年5月本院收治的A1型胸腰椎骨折患者129例为研究对象。按照随机数字表简单随机分为A、B、C组,各43例。A组患者采取跨伤椎置钉治疗方式,B组患者采取经伤椎单侧置钉方式,C组患者采取经伤椎双侧置钉方式。对治疗收三组均随访1年,比较三组患者手术指标、疗效及并发症的差异。结果:随访中,三组患者均顺利手术,术中均未出现血管、神经和内脏损伤等严重并发症。A组术中出血量、手术时长均低于B、C组(P<0.05),下地行走时间、完全负重时间、住院时间、伤椎前缘高度比丢失率及伤椎矢状位Cobb角丢失率均高于B、C组(P<0.05),但B、C组之间比较无明显差异(P>0.05)。重复测量方差分析显示,术后1周、1年,A组伤椎矢状位Cobb角、伤椎前缘高度压缩率、Oswestry功能障碍得分均高于B、C组,差异有统计学意义(P<0.05)。结论:经伤椎侧置钉治疗A1型胸腰椎骨折患者疗效优于跨伤椎置钉,其可有效预防后期椎体高度丢失与后突畸形,改善患者预后。且经伤椎单、双侧置钉间疗效无明显区别,临床可根据患者情况进行方案选择。Objective:To explore the effect of single,bilateral nail and trans-nail on the efficacy and complications of type A1 thoracolumbar fracture.Methods:A total of 129 patients with A1 thoracolumbar fractures admitted from May 2019 to May 2020 were selected as the subjects who were simply randomly divided into group A,B and C,43 cases in each.Patients in group A were treated with trans-vertebral screw placement,patients in group B with trans-vertebral screw placement on one side,patients in group C with trans-vertebral screw placement on both sides.The three groups were followed up for 1 year to compare the differences in surgical indexes,efficacy and complication.Results:During the follow-up,all patients had no serious complications such as vascular,nerve and visceral injuries during the operation.The amount of intraoperative blood loss and duration of operation in group A were lower than those in group B and C(P<0.05);walking time,full weight bearing time,hospital stay,ratio loss rate of anterior edge height and sagittal Cobb Angle loss rate of injured vertebrae were higher than those of B and C groups(P<0.05),but there was no significant difference between group B and group C(P>0.05).Repeated measures of ANOVA showed that 1 week and 1 year after surgery,Cobb Angle of sagittal position,high compression rate of anterior edge of injured vertebrae and Oswestry dysfunction score of injured vertebrae in group A were all higher than those in group B and C,and the differences were statistically significant(P>0.05).Conclusion:The treatment of injured vertebral nail in patients with A1 thoracic and lumbar fracture is better than the trans-injured vertebral nail,which can effectively prevent the late vertebral height loss and posterior protrusion deformity,and improve the prognosis of patients.Moreover,there is no obvious difference between single vertebra and bilateral nailing,which can be selected according to the patient's condition.

关 键 词：A1型胸腰椎骨折 经伤椎单侧置钉 经伤椎双侧置钉 跨伤椎置钉 疗效 预后 

分 类 号：R68[医药卫生—骨科学]