单节段与短节段固定治疗轻度胸腰椎骨折比较  

Mono-segment pedicle screw fixations versus short-segment counterpart for mild thoracolumbar fracture

作　　者：潘俊[1] 季一鸣[1] 田一星[1] 梅昕[1] 孙佳佳[1] 吴宸 刘凌[1] 何文野 PAN Jun;JI Yiming;TIAN Yi-xing;MEI Xin;SUN Jia-jia;WU Chen;LIU Ling;HE Wen-ye(Orthopedic Department,The First Affiliated Hospital,Suzhou University,Suhzou 215006,China)

机构地区：[1]苏州大学附属第一医院骨科,江苏苏州215006

出　　处：《中国矫形外科杂志》2023年第20期1848-1853,共6页Orthopedic Journal of China

摘　　要：[目的]比较单节段与短节段固定治疗轻度胸腰椎骨折的临床效果。[方法]2019年1月-2021年7月收治的轻度胸腰椎骨折患者62例,随机分成2组,32例依据骨折位置行伤椎与上椎或下椎单节段固定,30例行跨越伤椎的上下椎短节段固定。比较两组围手术期、随访和影像资料。[结果]两组均顺利手术,无严重并发症。单节段组手术时间[(39.6±21.5)min vs(54.4±26.9)min,P<0.05]、切口长度[(8.6±2.4)cm vs(11.3±3.9)cm,P<0.05]、术中失血量[(79.2±53.2)ml vs(112.6±63.7)ml,P<0.05]、术后下地行走时间[(3.3±2.3)d vs(5.7±3.5)d,P<0.05]均显著优于短节段组。两组患者随访时间平均(16.3±4.5)个月,单节段组恢复完全负重活动时间显著早于短节段组[(28.5±11.2)d vs(40.1±24.4)d,P<0.05]。随时间推移,两组疼痛VAS、ODI、JOA评分均显著改善(P<0.05)。术前两组上述指标的差异均无统计学意义(P>0.05),术后1周时单节段组VAS评分显著优于于短节段组[(2.4±1.5)vs(3.9±1.8),P<0.05],末次随访时,单节段组ODI评分显著优于短节段组[(10.9±2.4)vs(13.5±3.9),P<0.05]。影像方面,与术前相比,术后1周及末次随访时,两组AVH、PVH、Cobb角均显著改善(P<0.05)。术前两组间上述影像指标的差异均无统计学意义(P>0.05)。术后1周,单节段组AVH显著优于短节段组[(98.4±12.2)%vs(91.7±10.2)%,P<0.05],末次随访,单节段组AVH[(95.1±9.4)%vs(87.1±10.6)%,P<0.05]和局部后凸Cobb角[(2.3±5.8)°vs(5.9±7.4)°,P<0.05]均显著优于短节段组。[结论]单节段固定治疗轻度胸腰椎骨折具有手术切口小,手术时间、术中出血少等优势,可取得良好的稳定性及治疗效果。[Objective]To compare the clinical outcomes of mono-segment(MS)pedicle screw fixation versus short-segment(SS)counterpart for minor thoracolumbar fracture.[Methods]A total of 62 patients admitted our department from January 2019 to July 2021 for minor thoracolumbar fractures were randomly divided into 2 groups.Of them,32 patients received MS fixation of the injured vertebra with the upper or lower vertebra according to the fracture location,while the other 30 patients underwent SS pedicle screw fixation of the upper and lower vertebrae over the injured vertebrae.The document regarding to perioperative period,follow-up and images were compared be-tween the two groups.[Results]All patients in both groups had corresponding surgical procedures performed successfully without serious complications.The MS group proved significantly superior to the SS group in terms of operation time[(39.6±21.5)min vs(54.4±26.9)min,P<0.05],length of incision[(8.6±2.4)cm vs(11.3±3.9)cm,P<0.05],intraoperative blood loss[(79.2±53.2)ml vs(112.6±63.7)ml,P<0.05]and postoperative walking time[(3.3±2.3)days vs(5.7±3.5)days,P<0.05].All patients in both groups were followed up for(16.3±4.5)months in a mean,and the MS group resumed full weight-bearing activity significantly earlier than the SS group[(28.5±11.2)days vs(40.1±24.4)days,P<0.05].The VAS,ODI and JOA scores were significantly improved over time in both groups(P<0.05).Although there was no significant difference in the above indexes between the two groups before surgery(P>0.05),the MS group was significantly better than the SS group in VAS score 1 week after surgery[(2.4±1.5)vs(3.9±1.8),P<0.05],and ODI score at the last follow-up[(10.9±2.4)vs(13.5±3.9),P<0.05].Regarding imaging,the anterior vertebral height(AVH),posterior vertebral height(PVH)and local kyphotic Cobb angle signifi-cantly improved at 1 week after surgery and at the last follow-up compared with those preoperatively(P<0.05).There was no significant dif-ference in the above imaging indexes between the two groups

关 键 词：胸腰椎骨折 椎弓钉 单节段固定 短节段固定 

分 类 号：R683.2[医药卫生—骨科学]