胸腰椎骨折椎体水肿对经皮椎弓钉固定疗效的影响△

Effect of vertebral body edema on clinical outcomes of percutaneous pedicle screw fixation for thoracolumbar fracture

摘要:

[目的] 探讨胸腰椎骨折患者椎体水肿程度对经皮椎弓根螺钉内固定术（percutaneous pedicle screw fixation, PPSF） 临床疗效的影响。[方法] 回顾性分析2018 年2 月—2021 年5 月行PPSF 治疗的141 例胸腰椎骨折患者的临床资料。[结果] 依据术前MRI 影像椎体水肿程度将患者分为三组，其中轻度组55 例，中度组52 例，重度组34 例。三组患者手术时长、术中透视次数、切口总长度、术中失血量、一次置钉成功率、切口愈合等级、首次下地活动时间和住院时长的差异均无统计学意义（P＞0.05）。随访时间平均（18.5±2.4） 个月，三组患者完全负重活动时间的差异无统计学意义（P＞0.05）。术后随时间推移，三组患者VAS、ODI、JOA 评分均显著改善（P＜0.05）；相应时间点，三组间上述评分的差异均无统计学意义（P＞0.05）。影像方面，与术前相比，术后即刻及末次随访时，三组患者椎体前缘压缩率（anterior vertebral compression rate, AVCR） 和局部后凸Cobb 角（kyphotic angle, KA） 均显著减小（P＜0.05）。术前轻度组、中度组、中度组AVCR [(22.6±11.5) mm vs (29.1±9.8) mm vs(35.9±9.1) mm, P＜0.001] 和KA [(7.1±10.6)° vs (11.6±8.9)° vs (16.1±8.8)°, P＜0.001] 表现出逐渐增加的趋势，差异均具有统计学意义。术后即刻，三组患者的AVCR 和KA 差异均无统计学意义（P＞0.05）。末次随访时，三组患者AVCRR [(7.8±6.4) mm vs(10.7±6.8) mm vs (14.2±9.3) mm, P＜0.001] 和KA [(-0.7±7.8)° vs (4.2±7.6)° vs (8.6±6.2)°, P＜0.001] 再次呈现轻度组＜中度组＜重度组，差异具有统计学意义。[结论] 椎体严重水肿的患者，术后远期容易出现迟发性后凸畸形。

关键词:胸腰椎骨折;椎体水肿;局部后凸Cobb 角;远期后凸畸形

Abstract:

[Objective] To investigate the effect of vertebral body edema extent on clinical outcomes of percutaneous pedicle screw fixa-tion (PPSF) for thoracolumbar fracture. [Methods] A retrospective study was done on 141 patients who received PPSF for thoracolumbarfracture treated from February 2018 to May 2021. [Results] According to the vertebral body edema extent in preoperative MRI images, thepatients were divided into three groups, including 55 cases in mild group, 52 cases in moderate group and 34 cases in severe group. Therewere no statistically significant differences in operation duration, intraoperative fluoroscopy times, total incision length, intraoperative bloodloss, success rate of first screw placement, incision healing grade, postoperative walking time and length of hospital stay among three groups(P＞0.05). The mean follow-up time was (18.5±2.4) months, and there was no significant difference in time to resume full weight-bearing ac-tivity among the three groups (P＞0.05). The VAS, ODI and JOA scores were significantly improved over time in all three groups (P＜0.05),whereas which were not statistically significant among the three groups at any time points accordingly (P＞0.05). As for images, there wereno significant differences in anterior vertebral compression rate (AVCR) and local kyphotic Cobb angle (KA) among the three groups beforeand immediately after surgery (P＞0.05), but all with statistically significant differences at the preoperative and the latest follow-up. [Conclusion] The severe vertebral body edema preoperatively might lead to delayed kyphosis deformity in long term after PPSF.

Key words:thoracolumbar fracture; vertebral body edema; local kyphosis Cobb angle; long-term kyphosis deformity