椎旁肌间隙入路椎弓根螺钉内固定结合伤椎置钉方案对脊柱骨折患者伤椎恢复及疼痛的影响  

Effect of paravertebral space approach pedicle screw internal fixation combined with screw placement on recovery and pain of injured vertebra in patients with spinal fracture

作　　者：刘朋[1] 刘铭玥 薛博琼 梁兵鑫[1] 胡三保[1] Liu Peng;Liu Mingyue;Xue Boqiong;Liang Bingxin;Hu Sanbao(Department of Orthopaedics,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京安贞医院骨科,北京100029 [2]首都医科大学,北京100069

出　　处：《中国医药》2024年第7期1043-1046,共4页China Medicine

基　　金：国家自然科学基金(82271408)。

摘　　要：目的探究椎旁肌间隙入路椎弓根螺钉内固定结合伤椎置钉方案对脊柱骨折患者伤椎恢复及疼痛的影响。方法选取首都医科大学附属北京安贞医院2021年5月至2023年5月收治的50例脊柱骨折患者。采用抽签法将患者分为对照组和观察组,各25例。对照组采用棘突旁入路椎弓根螺钉内固定联合伤椎置钉治疗;观察组采用椎旁肌间隙入路椎弓根螺钉内固定结合伤椎置钉治疗。比较2组围手术期指标、疼痛度、椎体前缘高度改善状况、Cobb′s角、血清骨代谢指标水平、创伤因子水平。结果观察组术中出血量、手术时间、术后卧床时间、术后引流量、术后住院时间均少于/短于对照组,术后3 d疼痛视觉模拟量表评分低于对照组(均P<0.001)。术后3 d、3个月,观察组椎体前缘高度[(14.0±1.3)cm比(11.7±1.2)cm、(15.4±1.7)cm比(12.8±1.3)cm]、Ⅰ型前胶原氨基端前肽水平均高于对照组,Cobb′s角均小于对照组、Ⅰ型胶原羧基末端肽水平均低于对照组(均P<0.001)。术后3 d,观察组肌红蛋白、乳酸脱氢酶、肌酸激酶水平均低于对照组(均P<0.05)。结论椎弓根螺钉内固定结合伤椎置钉方案中使用椎旁肌间隙入路临床疗效更佳,具有手术切口小、时间短和恢复快的特征,且有助于患者伤椎恢复,减少疼痛,促进骨愈合。Objective To explore the effects of paravertebral space approach pedicle screw internal fixation combined with screw placement on the recovery and pain of injured vertebrae in patients with spinal fracture through paravertebral space approach.Method Fifty patients with spinal fracture admitted to Beijing Anzhen Hospital,Capital Medical University from May 2021 to May 2023 were selected.Patients were divided into control group and observation group by lottery method,with 25 cases each.The control group treated with lateral spinous approach pedicle screw internal fixation combined with screw placement of injured vertebrae;the observation group treated with pedicle screw internal fixation with paravertebral space approach combined with nail placement of injured vertebra.Perioperative indexes,pain degree,vertebral anterior margin height improvement,Cobb′s angle,serum bone metabolism indexes and trauma factor levels were compared between the two groups.Results The intraoperative blood loss,operation time,postoperative bed rest time,postoperative drainage and postoperative hospital stay in the observation group were less/shorter than those in the control group,and the visual analog scale score of pain in the observation group was lower than that in the control group 3 d after operation(all P<0.001).At 3 d and 3 months after operation,the height of the anterior edge of vertebral body in the observation group was higher than that in the control group[(14.0±1.3)cm vs(11.7±1.2)cm,(15.4±1.7)cm vs(12.8±1.3)cm],and the level of typeⅠprocollagen amino terminal peptide was higher than that in the control group;the Cobb′s angle was smaller than that in the control group,and the typeⅠcollagen carboxyl terminal peptide was lower than that of the control group(all P<0.001).Three days after operation,the levels of myoglobin,lactate dehydrogenase and creatine kinase in the observation group were lower than those in the control group(all P<0.05).Conclusions The clinical efficacy of using the paravertebral muscle gap approa

关 键 词：脊柱骨折 椎旁肌间隙入路椎弓根螺钉内固定 疼痛程度 

分 类 号：R683.2[医药卫生—骨科学]