| 钟凯华.长臂单轴椎弓根螺钉在单纯性胸腰椎压缩性骨折复位固定中的应用及对肌肉损伤的影响[J].安徽医药,2022,26(11):2265-2269. |
| 长臂单轴椎弓根螺钉在单纯性胸腰椎压缩性骨折复位固定中的应用及对肌肉损伤的影响 |
| Application of long-arm uniaxial pedicle screw in the reduction and fixation of simple thoracolumbar vertebral compression fractures and its influence on muscle injury |
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| DOI：10.3969/j.issn.1009-6469.2022.11.033 |
| 中文关键词: 脊柱骨折 胸腰椎 压缩性骨折 内固定 长臂单轴椎弓根螺钉 经肌间隙入路 肌肉损伤 |
| 英文关键词: Spinal fractures Thoracolumbar vertebra Compression fractures Internal fixation Long-arm uniaxial pedicle screw Transmuscular approach Muscle injury |
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| 目的分析长臂单轴椎弓根螺钉经 Wiltse入路在单纯性胸腰椎压缩性骨折中的应用效果及对肌肉损伤的影响。方法选取自 2018年 1月至 2020年 8月周口市中心医院收治的单纯性胸腰椎压缩性骨折病人 87例，根据复位固定术式不同，分为观察组 38例、对照组 49例，其中观察组采取长臂单轴椎弓根螺钉经 Wiltse入路，对照组采取 AF系统经传统后正中入路。记录两组病人围术期指标、手术前后血清肌肉损伤指标［肌酸激酶( CK)、肌红蛋白( Mb)］变化；采用疼痛视觉模拟评分( VAS)评价病人不同时间节点疼痛水平；经胸腰椎正侧位片检查获取伤椎原始高度( H0)、术前及术后 1周伤椎椎体前缘高度( H1H2)，计算术前、术后 1周伤椎相对高度( H1/H0、H2/H0)及伤椎复位率，并测量矢状位 Cobb角变化；随访 3个月，采用 Oswestry功能障、碍指数( ODI)评价功能障碍情况，并统计手术相关并发症。结果观察组手术时长、术中失血量、术后引流量及首次下床活动时间均明显短于或低于对照组( P<0.05)。术后 3d，两组血清 CK、Mb水平均较术前升高( P<0.05)，且观察组血清 CK、Mb水平 |
| 英文摘要: |
| Objective To analyze the application effect of long-arm uniaxial pedicle screw via Wiltse approach on simple thoraco.lumbar vertebral compression fractures and its influence on muscle injury.Methods Totally 87 patients with simple thoracolumbarvertebral compression fractures in Zhoukou Central Hospital from January 2018 and August 2020 were selected as the study subjects.According to different reduction and fixation methods, the patients were assigned into observation group (38 cases) and control group(49 cases). Observation group was given long-arm uniaxial pedicle screw via Wiltse approach, while control group applied AF systemvia traditional posterior median approach. The perioperative indexes and serum muscle injury indicators before and after surgery [cre.atine kinase (CK), myoglobin (Mb)] were recorded in the two groups, and visual analogue scale of pain (VAS) was used to evaluate thepain at different time nodes. The original height of the injured vertebra (H0) and anterior height of the injured vertebral body (H1, H2) be.fore surgery and at 1 week after surgery were obtained by thoracolumbar anteroposterior and lateral radiograph examination, and the rel.ative height of the injured vertebrae (H1/H0, H2/H0) and reduction rate of the injured vertebra were calculated before surgery and at 1week after surgery, and the sagittal Cobb angle was measured. At 3 months of follow-up, Oswestry disability index (ODI) was used to evaluate the dysfunction, and the surgery-related complications were statistically analyzed.Results The surgical time, intraoperativeblood loss, postoperative drainage volume and first ambulation time in observation group were significantly shorter than or lower thanthose in control group (P<0.05). At 3 d after surgery, the levels of serum CK and Mb in both groups were increased compared with those before surgery (P<0.05), and the levels of serum CK and Mb with (58.21±10.42) U/L and (92.37±18.85) μg/L in observation group weresignificantly lower than (86.74±23.29) U/L and (127.83±26.43) μg/L in control group (P<0.05). At 1 day, 3 day, and 1 week after sur. gery, the pain VAS scores of the two groups were lower than those before surgery (P<0.05), and the scores with (2.82±0.69) points,(1.68±0.47) points and (0.89±0.39) points in observation group were significantly lower than (4.47±1.21) points, (2.49±0.65) points and(1.33±0.52) points in control group at the same time point (P<0.05). At 1 week after surgery, there were no significant differences in the decreases of H2/H0, reduction rate of injured vertebrae and sagittal Cobb angle between the two groups (P>0.05). At 3 months after sur. gery, there was no significant difference in ODI value between the two groups (P>0.05). Except for one case of poor wound healing in control group, no other serious complications were seen in the two groups.Conclusion Long-arm uniaxial pedicle screw surgery viaWiltse approach is a minimally invasive and effective surgical method for the treatment of simple thoracolumbar vertebral compressionfractures, and it is beneficial to relieve the muscle injury and postoperative pain. |
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