长臂单轴椎弓根螺钉在单纯性胸腰椎压缩性骨折复位固定中的应用及对肌肉损伤的影响  

Application of long-arm uniaxial pedicle screw in the reduction and fixation of simple thoracolumbar vertebral compression fractures and its influence on muscle injury

作　　者：钟凯华[1] ZHONG Kaihua(Department of Orthopedics,Zhoukou Central Hospital,Zhoukou,Henan 466000,China)

机构地区：[1]周口市中心医院骨科,河南周口466000

出　　处：《安徽医药》2022年第11期2265-2269,共5页Anhui Medical and Pharmaceutical Journal

摘　　要：目的分析长臂单轴椎弓根螺钉经Wiltse入路在单纯性胸腰椎压缩性骨折中的应用效果及对肌肉损伤的影响。方法选取自2018年1月至2020年8月周口市中心医院收治的单纯性胸腰椎压缩性骨折病人87例,根据复位固定术式不同,分为观察组38例、对照组49例,其中观察组采取长臂单轴椎弓根螺钉经Wiltse入路,对照组采取AF系统经传统后正中入路。记录两组病人围术期指标、手术前后血清肌肉损伤指标[肌酸激酶(CK)、肌红蛋白(Mb)]变化;采用疼痛视觉模拟评分(VAS)评价病人不同时间节点疼痛水平;经胸腰椎正侧位片检查获取伤椎原始高度(H_(0))、术前及术后1周伤椎椎体前缘高度(H_(1)、H_(2)),计算术前、术后1周伤椎相对高度(H_(1)/H_(0)、H_(2)/H_(0))及伤椎复位率,并测量矢状位Cobb角变化;随访3个月,采用Oswestry功能障碍指数(ODI)评价功能障碍情况,并统计手术相关并发症。结果观察组手术时长、术中失血量、术后引流量及首次下床活动时间均明显短于或低于对照组(P<0.05)。术后3 d,两组血清CK、Mb水平均较术前升高(P<0.05),且观察组血清CK、Mb水平(58.21±10.42)U/L、(92.37±18.85)μg/L,均明显低于对照组的(86.74±23.29)U/L、(127.83±26.43)μg/L(P<0.05)。术后1 d、3 d、1周,两组疼痛VAS评分均较术前降低(P<0.05),且观察组(2.82±0.69)分、(1.68±0.47)分、(0.89±0.39)分,均明显低于对照组同时间点的(4.47±1.21)分、(2.49±0.65)分、(1.33±0.52)分(P<0.05)。术后1周,两组H_(2)/H_(0)、伤椎复位率及矢状位Cobb角降低幅度比较差异均无统计学意义(P>0.05)。术后3个月,两组ODI值比较差异无统计学意义(P>0.05)。除对照组术后出现1例切口愈合不良外,两组均未见其他严重并发症。结论长臂单轴椎弓根螺钉经Wiltse入路手术是治疗单纯性胸腰椎压缩性骨折的微创、有效术式,有利于减轻病人肌肉损伤及术后疼痛。Objective To analyze the application effect of long-arm uniaxial pedicle screw via Wiltse approach on simple thoraco-lumbar vertebral compression fractures and its influence on muscle injury.Methods Totally 87 patients with simple thoracolumbar vertebral compression fractures in Zhoukou Central Hospital from January 2018 and August 2020 were selected as the study subjects.According to different reduction and fixation methods,the patients were assigned into observation group(38 cases)and control group(49 cases).Observation group was given long-arm uniaxial pedicle screw via Wiltse approach,while control group applied AF system via traditional posterior median approach.The perioperative indexes and serum muscle injury indicators before and after surgery[cre-atine kinase(CK),myoglobin(Mb)]were recorded in the two groups,and visual analogue scale of pain(VAS)was used to evaluate the pain at different time nodes.The original height of the injured vertebra(H_(0))and anterior height of the injured vertebral body(H_(1),H_(2))be-fore surgery and at 1 week after surgery were obtained by thoracolumbar anteroposterior and lateral radiograph examination,and the rel-ative height of the injured vertebrae(H_(1)/H_(0),H_(2)/H_(0))and reduction rate of the injured vertebra were calculated before surgery and at 1 week after surgery,and the sagittal Cobb angle was measured.At 3 months of follow-up,Oswestry disability index(ODI)was used to evaluate the dysfunction,and the surgery-related complications were statistically analyzed.Results The surgical time,intraoperative blood loss,postoperative drainage volume and first ambulation time in observation group were significantly shorter than or lower than those in control group(P<0.05).At 3 d after surgery,the levels of serum CK and Mb in both groups were increased compared with those before surgery(P<0.05),and the levels of serum CK and Mb with(58.21±10.42)U/L and(92.37±18.85)μg/L in observation group were significantly lower than(86.74±23.29)U/L and(127.83±26.43)μg/L in control gr

关 键 词：脊柱骨折 胸腰椎 压缩性骨折 内固定 长臂单轴椎弓根螺钉 经肌间隙入路 肌肉损伤 

分 类 号：R687.3[医药卫生—骨科学]