基于创伤应激指标和脊柱功能探讨经伤椎短节段椎弓根钉固定术与跨伤椎椎弓根固定术治疗胸腰段脊柱骨折的临床价值  

Based on Traumatic Stress Indexes and Spinal Function,to Investigate the Clinical Value of Transinjured Short Segment Pedicle Fixation and Transinjured Transvertebral Pedicle Fixation in the Treatment of Thoracolumbar Spinal Fracture

作　　者：苑国峰 何宇 张印[2] Yuan Guofeng;He Yu;Zhang Yin(Department of Orthopedics and Traumatology,Second Affiliated Hospital of Nanyang Medical College,No.1 Ward,Nanyang 473000,Henan,China;Nanyang First People's Hospital Orthopedics Department Henan Nanyang 47300,China)

机构地区：[1]南阳医学高等专科学校第二附属医院骨伤科一病区,河南南阳473000 [2]南阳市第一人民医院骨一科,河南南阳473000

出　　处：《哈尔滨医药》2024年第4期16-19,共4页Harbin Medical Journal

基　　金：2023年度南阳市基础与前沿技术研究专项(23JCQY2057)。

摘　　要：目的探究经伤椎短节段椎弓根钉固定术与跨伤椎椎弓根固定术治疗胸腰段脊柱骨折的临床价值及对脊柱功能、创伤应激指标的影响。方法回顾性收集本院医治的91例胸腰段脊柱骨折患者临床资料,根据不同手术方法分为经伤椎组(n=47)、跨伤椎组(n=44),前者行经伤椎短节段椎弓根钉固定术,后者行跨伤椎椎弓根固定术。比较两组手术指标、手术前后脊柱功能[骨折椎体高度、矢状面Cobb角、腰椎活动能力]、创伤应激指标[皮质醇(COR)、肾上腺素(E)、去甲肾上腺素(NE)]、疼痛数字评估(NRS)及并发症状况。结果与跨伤椎组相比,经伤椎组出血量、医疗费用较少,手术时间、住院时间、切口长度、卧床时间较短(P<0.05);术后两组ODI评分、矢状面Cobb角、骨折椎体高度相比,差异无统计学意义(P>0.05);与跨伤椎组相比,经伤椎组术后血清COR、E、NE指标均较低(P<0.05);与跨伤椎组相比,经伤椎组术后NRS评分较低(P<0.05);经伤椎组并发症发生率(2.13%)与跨伤椎组(9.09%)相比,差异无统计学意义(P>0.05)。结论经伤椎短节段椎弓根钉固定术与跨伤椎椎弓根固定术均能改善患者脊柱功能,其中经伤椎短节段椎弓根钉固定术能减轻机体创伤应激反应,降低术后疼痛感,加快康复进程,安全性较高。Objective To investigate the clinical value of transsegmental pedicle fixation and transsegmental pedicle fixation in the treatment of thoracolumbar spinal fracture and the effects on spinal function and traumatic stress indexes.Methods The clinical data of 91 patients with thoracolumbar spinal fracture treated were retrospectively collected,and they were divided into transvertebral injured group(n=47)and transvertebral injured group(n=44)according to different surgical methods.The former underwent transvertebral short segment pedicle nail fixation,and the latter underwent transvertebral injured pedicle fixation.Surgical parameters,spinal function before and after surgery[fracture vertebral height,sagittal Cobb Angle,lumbar mobility],traumatic stress indicators[cortisol(COR),epinephrine(E),norepinephrine(NE)],numeric rating scales(NRS)and complications were compared between the two groups.Results Compared with the transvertebrae injured group,the amount of blood loss,medical expenses,operation time,hospital stay,incision length and bed time were shorter in the transvertebrae injured group(P<0.05).There was no significant difference in ODI score,sagittal Cobb Angle and vertebral body height between the two groups after surgery(P>0.05).The indexes of serum COR,E and NE in the injured vertebral group were lower than those in the injured vertebral group(P<0.05).The NRS score of the injured vertebral group was lower than that of the injured vertebral group(P<0.05).There was no significant difference in the incidence of complications between the injured vertebra group(2.13%)and the injured vertebra group(9.09%)(P>0.05).Conclusion Both transsegmental pedicle fixation and transsegmental pedicle fixation can improve the spinal function of patients.In particular,transsegmental pedicle fixation can alleviate the traumatic stress response,reduce postoperative pain,and accelerate the rehabilitation process with high safety.

关 键 词：脊柱功能 胸腰段脊柱骨折 椎弓根固定术 应激指标 疼痛程度 

分 类 号：R683.2[医药卫生—骨科学]