术前两步复位法结合HXN经皮椎弓根钉内固定术治疗胸腰段脊柱骨折的临床效果及安全性研究  

Clinical effect and safety of two-step reduction combined with HXN percutaneous pedicle screw internal fixation for the treatment of thoracolumbar spine fractures

作　　者：王毅飞 王胜利 黄一琳 卢彦肖 张树东 WANG Yi-fei;WANG Sheng-li;HUANG Yi-lin;LU Yan-xiao;ZHANG Shu-dong(Department of Orthopaedics,the First Affiliated Hospital of Henan University,Kaifeng 475000,Henan,CHINA)

机构地区：[1]河南大学第一附属医院骨科,河南开封475000

出　　处：《海南医学》2025年第3期353-359,共7页Hainan Medical Journal

基　　金：河南省开封市科技攻关项目(编号:2303030)。

摘　　要：目的探讨术前两步复位法结合脊柱矫形固定器(HXN型)经皮椎弓根钉内固定术治疗胸腰段脊柱骨折的临床效果及对关节功能的影响。方法选取2021年8月至2023年8月102例河南大学第一附属医院胸腰段脊柱骨折患者,以随机数表法分为观察组51例、对照组51例。对照组患者采取HXN经皮椎弓根钉内固定术治疗,观察组患者采取术前两步复位法结合HXN经皮椎弓根钉内固定术治疗。比较两组患者的手术指标,术前及术后1 d、3 d的创伤应激指标[皮质醇(Cor)、肿瘤坏死因子-α(TNF-α)、促肾上腺皮质激素(ACTH)],术前及术后7 d、1个月、3个月疼痛程度[视觉模拟评分(VAS)],术前及术后3个月影像学指标[伤椎矢状面指数(SI)、伤椎前缘高度比、伤椎压缩率、脊柱后凸角度(Cobb)]、关节功能[OSWESTRY功能障碍指数(ODI)、日本骨科协会评估治疗(JOA)评分],统计两组患者的并发症发生率。结果观察组患者的手术时间、住院时间分别为(52.13±8.26)min、(10.50±1.41)d,短于对照组的(65.39±10.04)min、(12.71±1.68)d,术中出血量为(176.34±31.39)m L,少于对照组的(232.50±37.42)m L,差异均有统计学意义(P<0.05);观察组患者术后1 d、3 d的血清TNF-α分别为(3.76±1.02)ng/mL、(2.83±0.46)ng/mL,低于对照组的(5.18±1.14)ng/mL、(3.44±0.70)ng/mL,Cor分别为(252.73±36.85)nmol/L、(221.61±30.24)nmol/L,低于对照组的(286.50±42.07)ng/mL、(254.18±35.98)ng/mL,ACTH分别为(52.59±8.22)ng/L、(46.23±6.81)ng/L,低于对照组的(63.17±10.79)ng/L、(55.48±8.52)ng/L,差异均有统计学意义(P<0.05);观察组患者术后7 d、1个月、3个月的VAS评分分别为(4.21±0.58)分、(3.03±0.32)分、(2.27±0.30)分,低于对照组的(4.75±0.62)分、(3.44±0.40)分、(2.83±0.36)分,差异均有统计学意义(P<0.05);观察组患者术后3个月的伤椎前缘高度比、SI分别为(89.68±3.10)%、(91.26±3.05)%,高于对照组的(87.46±2.67)%、(86.31±2.94)%,Cobb角、伤椎压缩�Objective To investigate the clinical effect of the two-step reduction combined with spinal orthopedic fixator(HXN type)percutaneous pedicle screw internal fixation for the treatment of thoracolumbar spine fractures and impact on joint function.Methods A total of 102 patients with thoracolumbar spine fractures in the First Affiliated Hospital of Henan University from August 2021 to August 2023 were selected and randomly divided into two groups using a random number table method,with 51 patients in the observation group and 51 patients in the control group.Patients in the control group underwent HXN percutaneous pedicle screw fixation,while those in the observation group underwent a two-step reduction combined with HXN percutaneous pedicle screw fixation.The surgical indicators of the two groups of patients were compared,including trauma stress indicators(cortisol[Cor],tumor necrosis factor-α[TNF-α],adrenocorticotropic hormone[ACTH])before surgery and at 1 d and 3 d after surgery,pain levels(Visual Analogue Scale[VAS])before surgery and at 7 d,1 month,3 months after surgery,imaging indicators(injury vertebral sagittal index[SI],height ratio of the anterior edge of the injured vertebrae,compression rate of the injured vertebrae,spinal kyphosis angle[Cobb]),joint function(Oswestry dysfunction index[ODI],Japanese Orthopaedic Association[JOA]Scoring System),and the incidence of complications in both groups of patients were statistically analyzed.Results The operation time and length of hospital stay in the observation group were(52.13±8.26)min and(10.50±1.41)d,which were significantly shorter than(65.39±10.04)min and(12.71±1.68)d in the control group(P<0.05).The intraoperative blood loss was(176.34±31.39)mL,significantly less than(232.50±37.42)mL of the control group(P<0.05).The serum TNF-αlevels in the observation group were(3.76±1.02)ng/mL and(2.83±0.46)ng/mL at 1 d and 3 d after surgery,which were significantly lower than(5.18±1.14)ng/mL and(3.44±0.70)ng/mL in the control group;Cor values were(252.73±

关 键 词：胸腰段脊柱骨折 术前两步复位法 HXN经皮椎弓根钉内固定术 疼痛 关节功能 伤椎前缘高度 

分 类 号：R683.2[医药卫生—骨科学]