| 刘孝峰,孙良业,窦强兵,等.经伤椎单双侧置钉与不置钉治疗胸腰段骨折的疗效比较[J].安徽医药,2020,24(3):520-524. |
| 经伤椎单双侧置钉与不置钉治疗胸腰段骨折的疗效比较 |
| Comparison of unilateral or bilateral pedicle screw fixation at the level of fracture versus posterior fixation alone in the treatment of thoracolumbar fractures |
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| DOI：10.3969/j.issn.1009?6469.2020.03.025 |
| 中文关键词: 脊柱骨折 胸椎 腰椎 骨折固定术，内 骨钉 |
| 英文关键词: Spinal fractures Thoracic vertebrae Lumbar vertebrae Fracture fixation,internal Bone nails |
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| 中文摘要: |
| 目的比较后路短节段经伤椎单双侧置钉与不置钉治疗胸腰段椎体骨折的临床疗效。方法采用回顾性分析的方法，自 2017年 1—12月，安徽医科大学附属六安医院采用后路短节段椎弓根钉内固定术治疗胸腰段单一椎体骨折病人 98例。根据伤椎置钉多少分为三组:跨伤椎置钉组( A组) 32例，单侧伤椎置钉组( B组) 28例，双侧伤椎置钉组( C组) 38例，随访时间范围为 12~20个月，平均 16.2个月，对三组病人的术中、术后及末次随访相关指标进行比较。结果三组病人的手术时间［A组(88.00±11.75)min，B组( 87.63±11.85)min，C组( 89.97±11.28)min，F＝0.405］、术中出血量［A组( 107.81±16.09)mL，B组(111.72±20.02)mL，C组( 113.43±19.18)mL，F＝0.825］、术后疼痛视觉模拟评分( VAS)［A组( 3.19±0.93)分， B组( 3.36±0.83)分， C组(3.34±0.77)分， F＝0.383］、术后第 3天的伤椎前缘高度比［A组(96.07±2.23)%，B组(96.79±2.90)%，C组( 96.75±3.76)%，F＝0.545］及矢状位 Cobb角［A组( 5.07±1.95)°，B组( 4.40±1.34)°，C组( 4.29±1.66)°，F＝2.060］比较均差异无统计学意义( P＞0.05)。末次随访时， B、C组病人的伤椎前缘高度比［A组( 92.79±1.97)%，B组( 94.12±2.00)%，C组( 95.00±1.70)%，F＝12.079］、矢状位 Cobb角［A组( 7.77±1.87)°，B组( 6.47±1.54)°，C组( 6.38±1.58)°，F＝7.046］、伤椎复位丢失情况［高度丢失: A组( 3.01±1.18)%，B组( 2.26±0.87)%，C组( 1.83±0.60)%，F＝15.175；角度丢失: A组(2.68±1.06)°，B组( 2.07±0.85)°，C组(2.11±0.86)°，F＝4.349］与A组病人相比差异有统计学意义( P＜0.05)，B组与 C组病人相比差异无统计学意义( P＞0.05)。结论经伤椎置钉与传统的跨伤椎置钉相比在治疗胸腰段椎体骨折上能更有效的降低后期复位椎体高度的丢失和减少迟发型后凸畸形的发生；单侧置钉与双侧置钉疗效相似。 |
| 英文摘要: |
| Objective To compare the clinical effects of single or double screw placement and non?screw placement in the treat?ment of thoracolumbar vertebral body fracture.Methods In this retrospective study，98 patients with thoracolumbar fractures were treated in Lu’an Affiliated Hospital of Anhui Medical University with posterior short?segment pedicle screw fixation from Jan.2017to Dec.2017.According to the different fixation methods，the patients were divided into three groups:Group A included 32 patients treated by traditional short?segment pedicle screw fixation alone，Group B included 28 patients treated by posterior fixation with uni? lateral pedicle fixation at the level of fracture，and Group C included 38 patients treated by posterior fixation with bilateral fracture?level screws.The follow?up period ranged from 12 to 20 months，with an average of 16.2 months.Clinical and radiologic parameters were compared among the three groups in surgery，after surgery，and at latest follow?up.Results The patients among the three groups showed similar outcomes in operation time［group A(88.00±11.75)min，group B(87.63±11.85)min，group C(89.97± 11.28)min，F＝0.405］，the intraopertative blood loss［group A(107.81±16.09)mL，group B(111.72±20.02)mL，group C(113.43±19.18)mL，F＝0.825］，visual analogue scale(VAS)［group A(3.19±0.93)score，group B(3.36±0.83)score，group C(3.34±0.77) score，F＝0.383］scores for back pain，anterior height ratio of injured vertebra［group A(96.07±2.23)%，group B(96.79±2.90)%， group C(96.75±3.76)%，F＝0.545］and sagittal Cobb Angle［group A(5.07±1.95)°，group B(4.40±1.34)°，group C(4.29±1.66)°，F＝2.060］on the third day after surgery(P＞0.05).At the lastest follow?up，group B and C showed significant difference with group A in the ratio of anterior height of injured vertebrae［group A(92.79±1.97)%，group B(94.12±2.00)%，group C(95.00±1.70)%，F＝12.079］，sagittal Cobb Angle［group A(7.77±1.87)°，group B(6.47±1.54)°，group C(6.38±1.58)°，F＝7.046］， and the loss of injured vertebrae［Height loss:group A(3.01±1.18)%，group B(2.26±0.87)%，group C(1.83±0.60)%，F＝15.175； Angle loss:group A(2.68±1.06)°，group B(2.07±0.85)°，group C(2.11±0.86)°，F＝4.349］(P＜0.05)，while no statistical differ? ence was found between group B and group C(P＞0.05).Conclusion Compared with the traditional cross?wound vertebral pedi? cle screw fixation，unilateral or bilateral pedicle fixation at the level of fracture is more effective in the treatment of thoracolumbar vertebral fracture，which decrease the loss of injured vertebrae height and reduce the occurrence of delayed kyphosis. |
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