经安全三角区伤椎植骨联合后路内固定治疗胸腰椎爆裂性骨折的疗效观察  

Efficacy observation of trans-Kambin′s triangle bone grafting of injured vertebrae combined with posterior internal fixation in treatment of patients with thoracolumbar burst fracture

作　　者：董辉 王永祥 胡乐 蔡俊 张亮 冯新民 杨建东 陶玉平 DONG Hui;WANG Yongxiang;HU Le;CAI Jun;ZHANG Liang;FENG Xinmin;YANG Jiandong;TAO Yuping(Department of Orthopedics,Clinical Medical College of Yangzhou University,Subei People′Hospital in Jiangsu Province,Yangzhou,Jiangsu,225001;Graduate School of Dalian Medical University,Dalian,Liaoning,116044)

机构地区：[1]扬州大学临床医学院/江苏省苏北人民医院骨科,江苏扬州225001 [2]大连医科大学研究生院,辽宁大连116044

出　　处：《实用临床医药杂志》2022年第4期33-36,共4页Journal of Clinical Medicine in Practice

基　　金：江苏省医学创新团队培养项目(CXTDB2017004)。

摘　　要：目的 观察经安全三角区伤椎植骨联合后路内固定治疗胸腰椎爆裂性骨折的效果。方法 回顾性分析2017年1月—2019年12月脊柱外科收治的41例胸腰椎爆裂性骨折患者的临床资料,按术式的不同分为研究组20例(经安全三角区伤椎植骨联合后路内固定)和对照组21例(单纯后路内固定)。比较2组患者手术时间、术中出血量、住院时间、骨折愈合时间,以及术前及术后伤椎前缘高度比、伤椎Cobb角、视觉模拟评分法(VAS)评分、腰背部Oswestry功能障碍指数(ODI)评分和并发症等。结果 研究组手术时间长于对照组,骨折愈合时间短于对照组,差异有统计学意义(P<0.05)。术后1周时,研究组伤椎前缘高度比大于对照组;术后12个月及内固定取出后1个月时,研究组伤椎前缘高度比大于对照组,Cobb角小于对照组;研究组伤椎前缘高度比和Cobb角的矫正度丢失均小于对照组,上述组间差异均有统计学意义(P<0.05)。术后12个月及内固定取出后1个月时,研究组VAS评分、ODI评分均低于对照组,差异有统计学意义(P<0.05)。2组患者术后切口均达到Ⅰ期愈合,随访期间未出现螺钉和连接棒断裂及其他并发症,末次随访时Frankel评级均为E级。结论 经安全三角区伤椎植骨联合后路内固定治疗胸腰椎爆裂性骨折效果显著,能维持伤椎前缘高度比和Cobb角,且安全性高,值得临床应用。Objective To observe the effect of trans-Kambin′s triangle bone grafting of injured vertebrae combined with posterior internal fixation in the treatment of patients with thoracolumbar burst fracture. Methods Clinical materials of 41 patients with thoracolumbar burst fractures in the Department of Spinal Surgery from January 2017 to December 2019 were analyzed retrospectively, and they were divided into study group(20 cases, treated with trans-Kambin′s triangle bone grafting of injured vertebrae combined with posterior internal fixation) and control group(21 cases, only treated with posterior internal fixation) according to different operation methods. The operation time, intraoperative bleeding, hospital stay, fracture healing time, preoperative and postoperative height ratio of the anterior edge of the injured vertebra, Cobb angle of the injured vertebra, Visual Analogue Scale(VAS), Oswestry Dysfunction Index(ODI) of waist and back as well as complications were compared between the two groups. Results The operation time in the study group was significantly longer than that in the control group,while the fracture healing time was significantly shorter than that in the control group( P < 0. 05). At 1 week after operation,the height ratio of the anterior edge of the injured vertebrae in the study group was greater than that in the control group;at 12 months after operation and 1 month after removal of internal fixation,the height ratios of the anterior edge of the injured vertebrae in the study group were greater than that in the control group,and the Cobb angle was smaller than that in the control group;the correct degree losses in the height ratio of the anterior edge of the injured vertebrae and the Cobb angle in the study group were smaller than those in the control group;the between-group differences mentioned above were statistically significant( P <0. 05). At 12 months after operation and 1 month after removal of internal fixation,the VAS scores and ODI scores of the study group were significantly lower

关 键 词：胸腰椎爆裂性骨折 安全三角区 植骨术 内固定术 椎体前缘高度 COBB角 

分 类 号：R687.3[医药卫生—骨科学] R683.2[医药卫生—外科学]