不同压力球囊扩张结合撬拨复位植骨固定治疗胸腰椎骨折的效果及术后再骨折的影响因素  

Effect of different pressure balloon dilation combined with prying reduction and bone graft fixation in the treatment of thoracolumbar fractures and the risk factors of postoperative re-fracture

作　　者：刘明昊 许俊岭[1] 贺银川 曹鹏 魏然 姚雪莹[1] Liu Minghao;Xu Junling;He Yinchuan;Cao Peng;Wei Ran;Yao Xueying(Cangzhou Hospital of Traditional Chinese and Western Medicine,Hebei Province,Cangzhou 061000,China)

机构地区：[1]河北省沧州中西医结合医院骨伤一科,沧州061000

出　　处：《中国综合临床》2023年第2期85-90,共6页Clinical Medicine of China

基　　金：河北省青年科技课题(20200612)。

摘　　要：目的探讨不同压力球囊扩张结合撬拨复位植骨固定治疗胸腰椎骨折的效果及术后再骨折的影响因素。方法选取河北省沧州中西医结合医院2019年3月至2021年6月收治的胸腰椎骨折患者100例,采用前瞻性随机对照研究方法,应用随机数字表法分为3组,不完全扩张组33例,适度扩张组33例,完全扩张组34例。3组均采用球囊扩张结合撬拨复位植骨固定治疗,其中不完全扩张组、适度扩张组、完全扩张组球囊扩张压力分别为100、150 psi和不超过200 psi,球囊扩张容积分别为0.5∶1、1∶1、1.5∶1。比较3组手术时间、术中出血量、术后引流量、椎体前缘高度恢复率和住院时间,以及手术前后局部Cobb角、疼痛视觉模拟量表评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry dability index,ODI)评分。根据术后随访是否发生再骨折分组,比较再骨折组和未再骨折组的临床资料,分析胸腰椎骨折患者术后再骨折的危险因素。呈正态分布的计量资料以x¯±s表示,两组间比较采用独立样本t检验,3组间比较采用单因素方差分析或重复测量的方差分析,两两比较采用SNK-q检验;计数资料以例或例(%)表示,组间比较采用χ^(2)检验;应用Logistic回归分析胸腰椎骨折患者术后再骨折的危险因素。结果3组手术时间、术中出血量和术后引流量比较差异均无统计学意义(P值分别为0.096、0.328和0.344);适度扩张组椎体前缘高度恢复率高于不完全扩张组和完全扩张组[(84.15±4.21)%比(70.18±7.44)%、(75.94±6.56)%],住院时间短于不完全扩张组和完全扩张组[(10.38±2.35)d比(15.18±3.44)、(14.59±2.48)d](均P<0.001)。术前,3组患者的Cobb角、VAS和ODI评分比较差异均无统计学意义(均P>0.05);术后,3组患者Cobb角、VAS和ODI评分均低于术前,且适度扩张组均低于不完全扩张组和完全扩张组[(14.08±2.15)°比(16.48±4.85)°、(15.06±3.45)°,(1.81±0.53)分比(2.25±0.4Objective To investigate the effect of different pressure balloon dilation combined with prying reduction and bone graft fixation in the treatment of thoracolumbar fractures and the risk factors of postoperative re-fracture.Methods One hundred cases of thoracolumbar fracture patients admitted to Cangzhou Integrated Traditional Chinese and Western Medicine Hospital in Hebei Province from March 2019 to June 2021 were selected.Prospective randomized controlled study method was used and random number table method was used to divide them into three groups:incomplete expansion group(33 cases),moderate expansion group(33 cases)and complete expansion group(34 cases).All the 3 groups were treated with balloon dilation combined with prying reduction and bone graft fixation.The pressure of balloon dilation in incomplete dilation group,moderate dilation group and complete dilation group was 100 psi,150 psi and no more than 200 psi respectively,and the volume of balloon dilation was 0.5∶1,1∶1 and 1.5∶1 respectively.The operation time,intraoperative bleeding volume,postoperative drainage volume,vertebral anterior margin recovery rate and hospital stay,as well as local Cobb angle,visual analog scale(VAS)and Oswestry disability index(ODI)scores before and after operation were compared among the three groups.According to the follow-up of whether there is re-fracture after surgery,the clinical data of the re-fracture group and the non re-fracture group were compared,and the risk factors of the re-fracture after surgery were analyzed.The measurement data with normal distribution was expressed as:independent sample t-test was used for comparison between two groups,one-way ANOVA or repeated measurement ANOVA was used for comparison between three groups,and SNK-q test was used for comparison between two groups.Counting data were expressed in cases or cases(%),and compared between groups byχ^(2) Inspection.Logistic regression was used to analyze the risk factors of refracture after thoracolumbar fracture.Results There was no sig

关 键 词：胸腰椎骨折 球囊扩张 撬拨复位植骨固定术 术后再骨折 

分 类 号：R687.3[医药卫生—骨科学]