伤椎植钉与撑开复位的先后次序对轻中度胸腰椎爆裂骨折手术疗效的影响  

The effect of the sequence of intermediate instrumentation and distraction-reduction of the fractured vertebrae on the surgical treatment of mild to moderate thoracolumbar burst fractures

作　　者：张刚刚 李朋飞 祁朝阳 王培霞[1] 汪济海 段永壮[1] ZHANG Ganggang;LI Pengfei;QI Chaoyang;WANG Peixia;WANG Jihai;DUAN Yongzhuang(Departement of Orthopedics,the First Affiliated Hospital of Zhengzhou University,Zhengzhou Henan,450052,P.R.China;Departement of Orthopedics,Sun Yat-sen Memorial Hospital of Sun Yat-sen University,Guangzhou Guangdong,510000,P.R.China;Departement of Orthopedics,People's Hospital ofLuoning County,Luoyang Henan,471000,P.R.China)

机构地区：[1]郑州大学第一附属医院骨科,郑州450052 [2]中山大学孙逸仙纪念医院骨外科,广州510000 [3]洛阳市洛宁县人民医院骨科,河南洛阳471000

出　　处：《中国修复重建外科杂志》2022年第5期600-608,共9页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨后路切开短节段内固定治疗轻中度胸腰椎爆裂骨折时,伤椎植入长螺钉与撑开复位的先后次序对手术疗效的影响。方法回顾分析2016年1月—2019年6月收治且符合选择标准的68例轻中度胸腰椎爆裂骨折患者临床资料,根据治疗方式分为先伤椎植钉再钉棒撑开复位内固定(intermediate screws then distraction-reduction fixation,ISDRF)组(32例)以及先钉棒撑开复位再伤椎植钉内固定(distraction-reduction then intermediate screws fixation,DRISF)组(36例)。两组患者年龄、性别、身体质量指数、骨折节段、致伤原因及术前载荷分享评分、胸腰椎损伤分型和严重评分、椎管侵占率、背部疼痛视觉模拟评分(VAS)、伤椎前缘高度、Cobb角等一般资料比较差异无统计学意义(P>0.05)。记录并比较两组患者手术时间、术中出血量、并发症发生情况及骨折愈合时间;手术前后采用椎管侵占率、伤椎前缘高度、后凸Cobb角和背部VAS评分评价患者疗效。结果两组患者手术时间和术中出血量比较差异均无统计学意义(P>0.05);术中均未出现血管、脊髓神经损伤,术后无切口深部感染及皮肤感染等并发症发生。术后1周两组椎管侵占率均较术前明显改善(P<0.05),两组间比较手术前后椎管侵占率差值及改善率差异均无统计学意义(P>0.05)。两组患者均获随访,随访时间18~24个月,平均22.3个月。术后6个月两组患者骨折均愈合。末次随访时,两组均未出现断钉、断棒等内固定物松动并发症;ISDRF组2例患者在内固定物取出后出现轻度背痛。组内比较显示,术后各时间点两组患者背痛VAS评分、伤椎前缘高度及Cobb角均较术前明显改善(P<0.05),术后12个月及末次随访时两组背痛VAS评分较术后1周亦有改善(P<0.05);末次随访时ISDRF组伤椎前缘高度较术后1周及12个月均有显著丢失(P<0.05),Cobb角较术后1周时有显著丢失(P<0.05);DRISF组伤椎前缘高�Objective To investigate the effect of the sequence of intermediate instrumentation with long screws and distraction-reduction on mild to moderate thoracolumbar fractures treated by posterior open and short-segmental fixation.Methods The clinical data of 68 patients with mild to moderate thoracolumbar burst fractures who met the selection criteria between January 2016 and June 2019 were retrospectively analyzed.The patients were divided into group ISDRF(intermediate screws then distraction-reduction fixation,32 cases)and group DRISF(distraction-reduction then intermediate screws fixation,36 cases)according to the different operation methods.There was no significant difference between the two groups in age,gender,body mass index,fracture segment,cause of injury,and preoperative load-sharing classification score,thoracolumbar injury classification and severity score,vertebral canal occupational rate,back pain visual analogue scale(VAS)score,anterior height of fractured vertebra,and Cobb angle(P>0.05).The operation time,intraoperative blood loss,complications,and fracture healing time were recorded and compared between the two groups.The vertebral canal occupational rate,anterior height of fractured vertebra,kyphosis Cobb angle,and back pain VAS score before and after operation were used to evaluate the effectiveness.Results There was no significant difference in intraoperative blood loss and operation time between the two groups(P>0.05).No vascular or spinal nerve injury and deep infections or skin infections occurred in both groups.At 1 week after operation,the vertebral canal occupational rate in the two groups was significantly improved when compared with that before operation(P<0.05),no significant difference was found in the difference of vertebral canal occupational rate before and after operation and improvement between the two groups(P>0.05).The patients in both groups were followed up 18-24 months,with an average of 22.3months.All vertebral fractures reached bone union at 6 months postoperatively.At last f

关 键 词：胸腰椎爆裂骨折 后凸畸形 椎管占位 伤椎植钉次序 后路短节段 内固定 

分 类 号：R687.3[医药卫生—骨科学]