椎弓根螺钉3种入路内固定治疗胸腰段骨折:脊柱功能、椎体高度复位与局部Cobb角的恢复  

Three approaches of pedicle screw internal fixation for thoracolumbar fractures:spinal function,vertebral height reduction and local Cobb angle recovery

作　　者：宋达玮[1] 于浩 杨明[1] 谢海峰 武岑灏 颜奇 王英杰 杨惠林[1] 耿德春[1] 钮俊杰 王金宁[1] Song Dawei;Yu Hao;Yang Ming;Xie Haifeng;Wu Cenhao;Yan Qi;Wang Yingjie;Yang Huilin;Geng Dechun;Niu Junjie;Wang Jinning(Department of Orthopedics,First Affiliated Hospital of Soochow University,Suzhou 215006,Jiangsu Province,China)

机构地区：[1]苏州大学附属第一医院骨科,江苏省苏州市215006

出　　处：《中国组织工程研究》2022年第36期5844-5848,共5页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金(81902181),项目负责人:钮俊杰。

摘　　要：背景:椎弓根螺钉内固定手术是治疗胸腰段骨折的首选之一,目前关于经皮、经Wiltse入路和传统后正中入路置钉的治疗效果存在一定争议。目的:探究经皮、经Wiltse入路和传统后正中入路置入椎弓根螺钉内固定治疗胸腰段骨折的临床效果。方法:回顾性分析2017年2月至2019年10月苏州大学附属第一医院收治的胸腰段骨折患者的病历资料,共纳入46例,均接受椎弓根螺钉内固定治疗,其中15例经皮打钉、17例经Wiltse入路置钉、14例经后正中入路置钉。比较3入路组患者手术前后的血清肌酸激酶水平、目测类比评分、Qswestry功能障碍指数、日本骨科协会(JOA)评分及伤椎前缘相对高度和矢状面后凸Cobb角。结果与结论:①46例患者均顺利完成手术,随访期间未出现内固定断裂等并发症;②3组患者术后3 d的肌酸激酶水平均高于术前(P<0.05),术后3 d的肌酸激酶水平为经皮打钉组<Wiltse入路组<后正中入路组(P<0.05);③3组患者术后的目测类比评分、Qswestry功能障碍指数评分、JOA评分均较术前明显改善(P<0.05),术后3 d及内固定取出后,经皮打钉组的Qswestry功能障碍指数评分、JOA评分优于Wiltse入路组、后正中入路组(P<0.05),Wiltse入路组的Qswestry功能障碍指数评分、JOA评分优于后正中入路组(P<0.05);④3组术后3 d及内固定取出后的伤椎前缘相对高度及矢状面后凸角较术前明显好转(P<0.05),3组间术后的伤椎前缘相对高度、矢状面后凸Cobb角比较差异均无显著性意义(P>0.05);⑤结果提示,相对于后正中入路,经皮打钉和Wiltse入路置入椎弓根螺钉对椎旁肌肉的影响较小,更利于胸腰椎骨折患者术后功能的恢复。BACKGROUND:Pedicle screw internal fixation is one of the main first choices for the treatment of thoracolumbar fractures.The therapeutic effects of percutaneous pedicle screw,Wiltse approach,and conventional approach remain in controversy.OBJECTIVE:To evaluate the clinical effects of percutaneous pedicle screw,Wiltse approach,and conventional approach in the treatment of thoracolumbar fractures.METHODS:A retrospective analysis of the medical records of patients with thoracolumbar fractures admitted to First Affiliated Hospital of Soochow University from February 2017 to October 2019 was performed.A total of 46 cases were enrolled and all received pedicle screw internal fixation,of which 15 cases received percutaneous screw placement,17 cases through the Wiltse approach,and 14 cases through the posterior median approach.Serum creatine kinase level,visual analogue scale score,Qswestry dysfunction index,Japanese Orthopaedic Association(JOA)score,the relative height of the anterior edge of the injured vertebrae and the sagittal kyphotic Cobb angle were compared before and after the operation in the three groups.RESULTS AND CONCLUSION:(1)All 46 patients underwent surgeries successfully with no complications such as internal fixation breakage.(2)The creatine kinase levels of the three groups 3 days after operation were higher than those before operation(P<0.05).The level of creatine kinase at 3 days after operation was percutaneous pedicle screw group<Wiltse approach group<posterior median approach group(P<0.05).(3)The visual analogue scale scores,Qswestry dysfunction index,and JOA scores of the three groups after surgery were significantly improved compared with those before surgery(P<0.05).At 3 days after operation and the internal fixation removal,the Qswestry dysfunction index and JOA score of the percutaneous pedicle screw group were better than those of the Wiltse approach group and the posterior median approach group(P<0.05).Qswestry dysfunction index and JOA score were better in the Wiltse approach group than t

关 键 词：胸腰段骨折 手术治疗 椎弓根螺钉 手术入路 Wiltse入路 后正中入路 临床疗效 

分 类 号：R459.9[医药卫生—治疗学] R687.32[医药卫生—临床医学]