经伤椎与跨伤椎固定胸腰椎爆裂骨折的比较

Comparison of thoracolumbar burst fractures with or without screw placement in the fractured vertebrae

摘要:

［目的］ 比较经伤椎与跨伤椎椎弓钉复位固定单纯胸腰椎爆裂骨折的临床效果。［方法］ 回顾性分析 2017 年 3 月— 2020 年 3 月本院手术治疗单纯胸腰椎爆裂骨折 96 例患者的临床资料。根据医患沟通结果，50 例采用经伤椎椎弓根置钉后路复位内固定术，46 例采用跨伤椎后路复位内固定术。比较两组围手术期、随访与影像学资料。［结果］ 两组患者均顺利完成手术，无严重并发症。经伤椎组的手术时间、术中出血量及切口长度显著多于跨伤椎组 （P<0.05），而下床时间及住院时间显著少于跨伤椎组 （P<0.05）。所有患者随访 （15.52±3.41） 个月，经伤椎组恢复完全负重活动显著早于跨伤椎组 （P<0.05）。随时间推移，两组的 VAS 和 ODI 评分显著下降 （P<0.05）。术前两组间 VAS、ODI 评分的差异均无统计学意义 （P>0.05），但是术后相应时间点，经伤椎组的 VAS、ODI 评分均明显优于跨伤椎组 （P<0.05）。影像方面，与术前相比，两组术后伤椎前缘高度比显著增加（P<0.05），而局部 Cobb 角显著下降（P<0.05）；术前两组间伤椎前缘高度比和局部后凸 Cobb 角的差异均无统计学意义（P>0.05），术后 3 d 和末次随访时，两组椎体前缘高度和局部后凸 Cobb 角的矫正均有丢失，经伤椎组的差异无统计学意义 （P>0.05），跨伤椎组椎体前缘高度差异有统计学意义 （P<0.05）。［结论］ 经伤椎椎弓钉复位固定单纯胸腰椎爆裂骨折的复位质量、稳定性均显著优于传统跨伤椎椎弓钉复位固定。

Abstract:

[Objective] To compare the clinical outcomes of pedicle screw fixation with or without screw placement in the fractured ver- tebrae for simple thoracolumbar burst fractures. [Methods] A retrospective study was done on 96 patients who underwent surgical treatment for simple thoracolumbar burst fracture in our hospital from March 2017 to March 2020. According to the results of doctor-patient commu- nication preoperatively, 50 patients had pedicle screw fixation performed with screw placement at the fractured vertebrae (the SPFV group) , while the remaining 46 patients received pedicle screw fixation without screw placement at the fractured vertebrae (the non-SPFV group) . The documents regarding to perioperative period, follow-up and radiographs were compared between the two groups. [Results] All the patients in both groups were operated on successfully without serious complications. Although the SPFV group consumed operative time, intraoperative blood loss, and incisive length significantly greater than the non-SPFV group (P＜0.001) , the former resumed postopera- tive ambulation significantly earlier, associated with significantly shorter hospital stay than the latter (P＜0.001) . All patients were followed up for (15.52±3.41) months, and the SPFV group recovered full weight-bearing activity significantly earlier than the non-SPFV group (P＜ 0.001) . VAS and ODI scores decreased significantly over time in both groups (P＜0.001) . There were no statistically significant differences in VAS and ODI scores between the two groups before surgery (P＞0.05) , however, the SPFV group proved significantly superior to the nonSPFV group in the VAS and ODI scores postoperatively (P＜0.001) . Radiographically, the anterior height ratio of the injured vertebrae sig- nificantly increased (P＜0.001) , while the local kyphotic Cobb's angle significantly decreased postoperatively compared with those preopera- tively in both groups (P＜0.001) . Nevertheless there were no statistically significant differences in the anterior height ratio of the injured ver- tebrae and local kyphotic Cobb's angle between the two groups before operation (P＞0.05) . Campared with those at 3 days after operation and the last follow-up, the above imaging indexes were lost in both groups, which proved not statistically significant in the SPFV group (P＞ 0.05) , whereas statistically significant in term of anterior height ration of the injured vertebrae in the non-SPFV group (P＜0.05) . [Conclusion] The pedicle screw fixation with SPFV is considerably superior to that without SPFV in traditional way in terms of fracture reduction quality and fixation stability for simple thoracolumbar fractures.