“张筋撑骨”复位椎弓根钉固定单节段胸腰椎骨折△（开放获取）

“Stretching soft tissue and distracting bone” reduction combined with percutaneous pedicle screw fixation for single-seg-ment thoracolumbar fracture

摘要:

[目的] 比较“张筋撑骨”复位法和单纯经皮椎弓根螺钉撑开复位法治疗单节段胸腰椎骨折的临床疗效。[方法] 回顾性分析2019 年1 月—2021 年6 月本院收治的47 例单节段胸腰椎骨折患者的临床资料，所有患者均为A 型无神经症状。依据术前医患沟通结果，24 例采用“张筋撑骨”复位法经皮椎弓钉固定（复位组），另外23 例采用单纯经皮椎弓根螺钉固定（常规组）。比较两组围手术期、随访和影像资料。[结果] 两组切口总长度、术中失血量、一次置钉成功率、下地行走时间、切口愈合等级、住院时间及早期并发症发生率的差异无统计学意义（P＞0.05），但复位组手术时间[(74.0±4.6) min vs (58.8±7.4)min, P＜0.001]、术中透视次数[(32.3±2.8) 次vs (26.1±3.2) 次, P＜0.001] 均显著多于常规组。随访时间平均（15.2±2.5） 个月。术后随时间推移，两组VAS、ODI 评分均显著改善（P＜0.05），末次随访，复位组ODI 评分[(1.4±0.9) vs (3.1±1.6) , P＜0.001] 显著优于常规组。影像方面，术后LKA、VWA、AVH 均显著改善（P＜0.05），末次随访复位组LKA [(2.3±2.1)° vs (6.2±3.6) °, P＜0.001]、VWA [(2.8±0.7)° vs (6.7±2.0) °, P＜0.001]、AVH [(94.1±2.5) % vs (85.7±4.9) %, P＜0.001] 均显著优于常规组。[结论] 采用“张筋撑骨”复位法治疗单节段胸腰椎骨折，可以较好地恢复伤椎高度、矫正椎体楔形变、避免后凸畸形发生，维持长远期的临床疗效。

Abstract:

[Objective] To compare the clinical efficacy of "stretching soft tissue and distracting bone” reduction combined with per-cutaneous pedicle screw fixation (PSF) versus PSF only for single-segment thoracolumbar fracture. [Methods] A retrospective study wasdone on 47 patients who received surgical treatment for type A single-segment thoracolumbar fracture without neurological symptoms inour hospital from January 2019 to June 2021. According to the preoperative doctor-patient discussion, 24 patients received "stretching softtissue and distracting bone” reduction combined with PSF (the reduction group), while other 23 patients had PSF performed only (the con-ventional group). The documents regarding perioperative period, follow-up and images were compared between the two groups. [Results] Al-though there were no significant differences in total incision length, intraoperative blood loss, success rate of one-time screw placement,postoperative walking time, grade of incision healing, hospital stay and incidence of early complications between the two groups (P＞0.05),the reduction group was significantly greater than the conventional group in terms of operation time [(74.0±4.6) min vs (58.8±7.4) min, P＜0.001] and intraoperative fluoroscopy times [(32.3±2.8) times vs (26.1±3.2) times, P＜0.001]. All the patients in both group were followed upfor a mean of (15.2±2.5) months. The VAS and ODI scores in both groups were significantly improved over time after surgery (P＜0.05), andthe reduction group proved significantly better than the conventional group in term of ODI scores at the last follow-up [(1.4±0.9) vs (3.1±1.6), P＜0.001]. Radiographically, the local kyphotic angle (LKA), vertebral wedge angle (VWA) and anterior vertebral height (AVH) weresignificantly improved in both group after surgery (P＜0.05). By comparison, the reduction group was significantly superior to the convention-al group in terms of LKA [(2.3±2.1) ° vs (6.2±3.6) °, P＜0.001], VWA [(2.8±0.7) ° vs (6.7±2.0) °, P＜0.001] and AVH [(94.1±2.5) % vs (85.7±4.9) %, P＜0.001] at the latest follow-up. [Conclusion] This "stretching soft tissue and distracting bone” reduction combined with percuta-neous pedicle screw fixation (PSF) does restore the height of the injured vertebra better to correct the wedge-shaped vertebral deformity,avoid the occurrence of kyphosis, and maintain the long-term clinical effect for single-segment thoracolumbar fracture.