经皮椎弓根螺钉治疗胸腰段脊柱骨折对椎体功能和炎症水平的影响

Effect of percutaneous pedicle screw fixation on vertebral function and inflammation in thoracolumbar spine fracture

目的观察经皮椎弓根螺钉和开放椎弓根螺钉治疗胸腰段脊柱骨折的疗效及其对椎体功能和炎症水平的影响。方法选择2016年1月至2017年12月在上海市第八人民医院收治的胸腰段脊柱骨折患者92例,其中男性60例,女性32例;年龄19~59岁,平均年龄35.01岁;坠落伤54例,砸伤29例,交通伤9例;根据骨折部位,T109例,T1119例,T1223例,L123例,L218例;根据AO分型,A1型42例,A2型33例,A3型17例。根据手术方式不同分为观察组和对照组,每组各46例。观察组予以经皮椎弓根螺钉治疗,对照组予以传统开放椎弓根螺钉治疗。比较两组术后疗效、手术时间、术中出血量、切口长度、术后镇痛时间、下床活动时间和住院时间,以及两组治疗前后椎体前缘高度、后凸Cobb角、Oswesry功能障碍指数(ODI)、美国脊髓损伤协会(ASIA)评分、高敏C反应蛋白(hs-CRP)、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-1β和高迁移率族蛋白B1(HMGB-1)。结果观察组总有效率97.83%,对照组93.48%;两组总有效率差异无统计学意义(χ~2=0.261,P> 0.05)。观察组手术时间、术中出血量、切口长度、术后镇痛时间、下床活动时间和住院时间明显减少或者短于对照组(P <0.01)。观察组和对照组治疗前椎体前缘高度、后凸Cobb角、ODI、ASIA评分、hs-CRP、TNF-α、IL-1β和HMGB-1水平差异无统计学意义[(61.38±10.67)%vs (60.75±11.59)%,(16.34±2.67)°vs (16.73±3.19)°,(15.34±6.38)%vs (15.68±7.16)%,(35.64±5.38)分vs (36.19±6.18)分,(6.38±0.96) mg/L vs (6.27±0.84) mg/L,(36.18±5.68) pg/mL vs (35.64±6.27) pg/mL,(17.38±2.37) pg/mL vs (17.15±3.58) pg/mL,(18.37±3.68) pg/mL vs (17.93±4.15) pg/mL;P> 0.05];治疗后观察组和对照组ODI和ASIA评分较治疗前明显降低或升高[ODI:(4.85±2.34)%vs (10.68±3.69)%;ASIA:(48.19±3.18)分vs (43.68±4.29)分;P <0.01],而观察组和对照组的hs-CRP、TNF-α、IL-1β和HMGB-1较治疗前明显降低[hs-CRP:(8.94±2.49) mg/L vs (10.86±3.17) mg/L;TNF-α:(43.68±8.64) pg/mL vs (58.67±6.47) pg/mL;IL-1β:(24.35±3.43) pg/mL vs (31.46±4.41) pg/mL;HMGB-1:(31.32±3.71) pg/mL vs (43.18±5.18) pg/mL;P <0.01];观察组ODI、ASIA评分降低或升高水平较对照组更加明显(P <0.01),而对照组hs-CRP、TNF-α、IL-1β和HMGB-1升高水平较观察组更加明显(P <0.01)。结论经皮椎弓根螺钉治疗胸腰段脊柱骨折疗效确切,具有微创、术后炎症反应轻和恢复快,有助于术后脊柱功能的恢复。

Objective To observe the effect of percutaneous pedicle screw and open pedicle screw in treatment of thoracolumbar spine fractures, and its impact on vertebral function and inflammation. Methods From January 2016 to December 2017,a total of 92 patients with thoracolumbar spine fractures were enrolled, which included 60 males and 32 females, aged 19-59 years old with mean age of 35.01 years old, 54 cases of fall injuries, 29 of injuries and 9 of traffic injuries. For the fracture site, there were 9 cases of T10, 19 of T11, 23 of T12, 23 of L1 and 18 of L2. For AO classification, 42 cases of type A1, 33 of type A2 and 17 of type A3. According to the different type of surgery, patients were divided into observation group(n = 46, treated with percutaneous pedicle screws) and control group(n = 46, treated with traditional open pedicle screws). The efficacy, operation time, intraoperative blood loss, incision length, postoperative analgesia time, evacuation active time and hospitalization time between 2 groups were compared. The anterior vertebral height, Cobb angle, Oswesry dysfunction index(ODI), American Spinal Cord Injury Association(ASIA) score, high-sensitivity C-reactive protein(hs-CRP), tumor necrosis factor(TNF)-α,interleukin(IL)-1β and high mobility group protein B1(HMGB-1) before and after treatment between 2 groups were compared.Results The total effective rate was 97.83 % in observation group, and 93.48 % in control group, and there was no significant difference between 2 groups(χ2= 0.261, P > 0.05). The operation time, intraoperative blood loss, incision length, postoperative analgesia time, evacuation active time and hospitalization time in observation group were significantly less or shorter than those in control group(P < 0.01). There were no significant differences in anterior vertebral height, Cobb angle, ODI, ASIA score, hs-CRP, TNF-α, IL-1β and HMGB-1 levels between 2 groups [(61.38 ± 10.67) % vs(60.75 ± 11.59) %,(16.34 ±2.67)° vs(16.73 ± 3.19)°,(15.34 ± 6.38) % vs(15.68 ± 7.16) %,(35.64 ± 5.38) scores vs(36.19 ± 6.18) scores,(6.38 ± 0.96) mg/L vs(6.27 ± 0.84) mg/L,(36.18 ± 5.68) pg/mL vs(35.64 ± 6.27) pg/mL,(17.38 ± 2.37) pg/mL vs(17.15 ± 3.58) pg/mL,(18.37 ±3.68) pg/mL vs(17.93 ± 4.15) pg/mL;P > 0.05]. The ODI and ASIA scores after treatment of 2 groups were significantly lower or higher than those of before treatment[ODI:(4.85 ± 2.34) % vs(10.68 ± 3.69) %;ASIA :(48.19 ± 3.18) scores vs(43.68 ±4.29) scores;P < 0.01], while hs-CRP, TNF-α, IL-1β and HMGB-1 after treatment of 2 groups were significantly lower than those of before treatment[hs-CRP:(8.94 ± 2.49) mg/L vs(10.86 ± 3.17) mg/L;TNF-α:(43.68 ± 8.64) pg/mL vs(58.67 ± 6.47)pg/mL;IL-1β:(24.35 ± 3.43) pg/mL vs(31.46 ± 4.41) pg/mL;HMGB-1:(31.32 ± 3.71) pg/mL vs(43.18 ± 5.18) pg/mL;P <0.01]. The ODI, ASIA scores of observation group decreased or increased more obviously than those of control group(P < 0.01),and hs-CRP, TNF-α, IL-1β and HMGB-1 of control group increased more obviously than those of observation group(P < 0.01).Conclusion It is demonstrated that percutaneous pedicle screw is effective in treatment of thoracolumbar spine fractures with the advantages of minimally invasive surgery, mild postoperative inflammatory response and rapid recovery, which is helpful for postoperative spinal function recovery.