复位前与复位后伤椎置钉固定胸腰椎骨折比较△

Comparison of pedicle screw placement at the fractured vertebra after and before fracture reduction for thoracolumbar fractures

摘要:

[目的] 比较复位棒辅助复位后伤椎置钉与常规复位前伤椎置钉短节段固定治疗 Magerl A3 型胸腰椎骨折的临床疗效。[方法]2018 年 12 月—2020 年 6 月收住本院的 59 例 Magerl A3 型胸腰椎骨折患者随机分为两组。所有患者均接受短节段椎弓根钉固定，其中，32 例采用自制复位棒复位后，再行伤椎置钉(复位置钉组)；27 例采用常规技术，复位前伤椎置钉(常规组)。比较两组围手术期、随访和影像资料。[结果] 两组患者均顺利完成手术，无严重术中并发症。两组手术时间、切口长度、术中失血量、术后引流量、下地行走时间及完全负重时间方面比较差异无统计学意义 (P＞0.05)。59 例患者随访时间 12~21 个月，平均 (14.42±2.04) 个月。随时间推移，两组的 VAS 及 ODI 评分均显著减少 (P＜0.05)，相应时间点，两组间 VAS 及 ODI 评分的差异均无统计学意义(P＞0.05)。影像学方面，与术前相比，术后两组的伤椎前缘相对高度、后凸 Cobb 角和椎管占位率均显著改善 (P＜0.05)。相应时间点，两组间伤椎前缘相对高度和 Cobb 角的差异无统计学意义 (P＞0.05)，但复位置钉组术后 3 d 及末次随访椎管占位率改善显著优于常规组(P＜0.05)。[结论]伤椎复位置钉与单纯置钉短节段固定治疗 Mag- erl A3 型胸腰椎骨折临床疗效无显著差异，但伤椎复位置钉椎管占位的改善优于单纯置钉。

Abstract:

[Objective] To compare the clinical outcomes of pedicle screw placement at the injured vertebra after and before fracture reduction in posterior short-segment fixation for Magerl type A3 thoracolumbar fractures. [Methods] From December 2018 to June 2020, 59 patients who were undergoing surgical treatment for Magerl type A3 thoracolumbar fractures were randomly divided into two groups. All the patients received posterior short-segment fixation with the intermediate screws. Of them, 32 patients had the screws at injured vertebra placed after fracture reduction by using self-developed reducing rods with the upper and lower pedicle screws (the reduced group), while the remaining 27 patients had the screws placed before fracture reduction as usual (the conventional group). The documents regarding to perioperative period, follow-up and radiographs were compared between the two groups. [Results] All patients in both groups had surgical procedures completed successfully without serious intraoperative complications. There was no statistically significant difference between the two groups in terms of operation time, intraoperative blood loss, incision length, hospital stay, the time to return walking and the time to resume full-weight bearing activity (P＞0.05) . All the 59 patients were followed up for 12-21 months with an average of (14.42±2.04) months. Both the VAS score and the ODI score decreased significantly in both groups over time (P＜0.05) , however, no significant differ- ence was noted in the two scores at any corresponding time point between the two groups (P＞0.05) . Regarding to radiographic assessment， the relative anterior vertebral height, kyphotic Cobb angle and spinal canal occupation ratio significantly improved postoperatively com- pared with those before operation in both groups (P＜0.05) . Although there was no statistically significant difference in the relative anterior vertebral height and kyphotic Cobb angle at any matching time point (P＞0.05) , the reduced group proved significantly superior to the con- ventional group in term of spinal canal occupation ratio at 3 days after operation and the latest follow- up (P＜0.05) . [Conclusion] Both short-segment pedicle screw fixation with screws placement at the injured vertebra after or before fracture reduction achieve satisfactory and comparable clinical outcomes for Magerl type A3 thoracolumbar fractures. However, the screws placed after fracture reduction does im- prove spinal canal occupation better.