经伤椎与跨伤椎6钉固定屈曲牵张型胸腰椎骨折  

Three-pair pedicle screws with or without placement in the injured vertebrae for flexion-distraction thoracolumbar fractures

作　　者：孙乐乐 梁成民[1] 尹稳 张伟[1] 李海江 于海洋[1] 焦伟[1] SUN Le-le;LIANG Cheng-min;YIN Wen;ZHANG Wei;LI Hai-jiang;YU Hai-yang;JIAO Wei(Fuyang Clinical College,Bengbu Medical College,Fuyang 236000,China)

机构地区：[1]蚌埠医学院附属阜阳医院(阜阳市人民医院),安徽阜阳236000

出　　处：《中国矫形外科杂志》2023年第6期481-486,共6页Orthopedic Journal of China

基　　金：蚌埠医学院自然科学重点项目(编号:BYKY2019227ZD);国家骨科与运动康复临床医学研究中心(编号:2021-NCRC-CXJJ-PY-35)。

摘　　要：[目的]比较经伤椎与跨伤椎6钉固定治疗屈曲牵张型胸腰椎骨折的临床疗效。[方法]回顾性分析2017年1月—2020年12月椎弓钉固定屈曲牵张胸腰椎骨折43例患者的临床资料。依据术前医患沟通结果,20例采用跨伤椎6钉固定,23例采用经伤椎6钉固定,比较两组围手术期、随访和影像学资料。[结果]所有患者顺利完成手术,术中无神经损伤,跨伤椎组切口长度显著大于经伤椎组(P<0.05);两组手术时间、术中失血量、术中透视次数、住院时间的差异均无统计学意义(P>0.05),两组切口均Ⅰ期愈合。随访时间平均(19.6±5.2)个月。两组患者下地行走时间、完全负重活动时间的差异无统计学意义(P>0.05)。随时间推移,两组VAS和ODI评分均显著降低(P<0.05),JOA评分显著增加(P<0.05),ASIA评级显著改善(P<0.05)。相应时间点,两组间上述指标的差异均无统计学意义(P>0.05)。影像方面,与术前相比,术后即刻及末次随访时两组椎体前缘相对高度、腰椎前凸角显著增加(P<0.05),而局部后凸Cobb角显著减小(P<0.05),术前两组上述影像指标的差异均无统计学意义(P>0.05),术后即刻和末次随访时,跨伤椎组上述指标均显著优于经伤椎组(P<0.05)。[结论]两组患者均取得满意的临床疗效,但跨伤椎6钉固定治疗屈曲牵张型胸腰椎骨折在矫正脊柱后凸畸形,维持伤椎高度恢复方面,优于经伤椎6钉固定。[Objective] To compare the clinical efficacy of 3-pair pedicle screws with or without placement in the injured vertebrae for flexion-distraction thoracolumbar fractures. [Methods] A retrospective study was performed on 43 patients who received pedicle screw fixation of flexion-distraction thoracolumbar fractures in our department from January 2017 to December 2020. According to the preoperative doctor-patient communication, 20 cases underwent 3-pair pedicle screws with non-placement in the injured vertebrae(PSNIV), while the remaining 23 cases received 3-pair pedicle screws with placement in the injured vertebrae(PSIV). The two groups were compared regarding perioperative, follow-up and radiographic documents. [Results] All patients in both groups received successful surgery with no injury to nerves. The PSNIV group had significantly longer incision than the PSIV(P<0.05), despite no significant difference in terms of operative time, intraoperative blood loss, intraoperative fluoroscopy and hospital stay between the two groups(P>0.05). Patients in both groups were followed up for 16~23 months, with an average of(19.6±5.2) months. There was no significant difference in the time to return walking and the time to resume full-weight bearing activity between the two groups(P>0.05). The ASIA grade for neurological function, as well as VAS,ODI and JOA scores improved significantly in both groups over time(P<0.05), whereas which proved not significantly different between the two groups at any matching time points(P>0.05). Regarding to radiographic assessment, the anterior vertebral height and lumbar lordosis of the two groups was significantly increased(P<0.05), while the local kyphotic Cobb Angle decreased significantly immediately postoperatively and at the latest follow-up compared with those preoperatively(P<0.05). There was no significant difference in the above imaging parameters between the two groups before operation(P>0.05). The PSNIV proved significantly superior to the PSIV in term of correction of the anterio

关 键 词：屈曲牵张型胸腰椎骨折 椎弓钉固定 跨伤椎6钉 经伤椎6钉 

分 类 号：R683.2[医药卫生—骨科学]