摘要
目的探讨经伤椎“前凸”置钉不植骨融合内固定治疗老年胸腰椎骨折患者的疗效。方法将86例老年胸腰椎骨折患者随机分成对照组和治疗组,各43例。对照组患者采用后路短节段跨伤椎4钉内固定术治疗,治疗组采用经伤椎“前凸”置钉不植骨融合内固定术治疗。比较两组围术期相关指标、伤椎前缘高度比、矢状面Cobb角、内固定失败发生率及日本骨科学会(JOA)评分。结果两组患者手术用时、术中出血量、术后住院时间的比较,差异均无统计学意义(均P>0.05)。术后1周时,两组患者的伤椎前缘高度比和矢状面Cobb角较术前均有改善(均P<0.05),但两组患者间上述指标差异均无统计学意义(均P>0.05);术后1年时,两组患者的伤椎前缘高度比和矢状面Cobb角较术前均有改善,而这改善较术后1周时有所丢失,且治疗组的伤椎前缘高度比大于对照组,矢状面Cobb角小于对照组(均P<0.05)。治疗组内固定失败发生率低于对照组,但两组间比较差异无统计学意义(P>0.05);两组术后1年JOA评分均高于术前(均P<0.05),但两组术后1年JOA评分差异无统计学意义(P>0.05)。结论应用经伤椎“前凸”置钉不植骨融合内固定治疗老年胸腰椎骨折患者可明显地提高患者的胸腰椎稳定性,有效地维持伤椎复位后的高度,减少后凸畸形矫正的丢失及内固定松动、断裂等并发症的发生,从而使患者获得良好预后。
Objective To investigate the efficacy of pedicle screw placement via"lordosis"of injured vertebrae and internal fixation without bone graft fusion for the treatment of elderly patients with thoracolumbar fractures.Methods Eighty-six elderly patients with thoracolumbar fractures were randomly divided into control group(n=43)and treatment group(n=43).Patients in the control group were treated with posterior short-segmental four-screw internal fixation across the injured vertebrae,whereas the treatment group was treated with pedicle screw placement via"lordosis"of injured vertebrae and internal fixation without bone graft fusion.The relevant perioperative indices,anterior edge height ratio of injured vertebrae,sagittal Cobb angle,incidence rate of failure in internal fixation,and the Japanese Orthopedics Association(JOA)score were compared between the two groups.Results There was no statistically significant difference in the operation duration,intraoperative blood loss,or postoperative length of hospital stay between the two groups(all P>0.05).One week after the operation,the anterior edge height ratio of injured vertebrae and the sagittal Cobb angle were improved in both groups as compared with those before the operation(all P<0.05),whereas there was no statistically significant difference in the aforementioned indices between the two groups(all P>0.05);one year after the operation,the anterior edge height ratio of injured vertebrae and the sagittal Cobb angle were improved in both groups than the preoperative indices,but the improvements were lost when compared with those one week after the operation;moreover,the treatment group exhibited a greater anterior edge height ratio of injured vertebrae and a smaller sagittal Cobb angle than the control group(all P<0.05).The incidence rate of failure in internal fixation was lower in the treatment group than in the control group,but showing no statistically significant difference between the two groups(P>0.05);the JOA scores of the two groups were increased one year after the operation as compared with those before the operation(all P<0.05),whereas there was no statistically significant difference in the JOA score one year after the operation between the two groups(P>0.05).Conclusion The application of pedicle screw placement via"lordosis"of injured vertebrae and internal fixation without bone graft fusion can significantly improve the stability of thoracolumbar spine,effectively maintain the post-reduction height of injured vertebrae,and reduce the loss of kyphosis correction as well as the incidence of complications such as internal fixator loosening and rupture in the treatment of elderly patients with thoracolumbar fractures;thereby,patients can obtain a favorable prognosis.
作者
邱星罡
郭宗信
王玉武
董红华
陈维东
顾红林
QIU Xing-gang;GUO Zong-xin;WANG Yu-wu;DONG Hong-hua;CHEN Wei-dong;GU Hong-lin(Department of Orthopedics,Yancheng Third People′s Hospital,Yancheng 224000,China)
出处
《广西医学》
CAS
2022年第3期279-283,共5页
Guangxi Medical Journal
基金
江苏省卫生和计划生育委员会医学科研项目(H2018059)。
关键词
伤椎“前凸”置钉
不植骨融合
内固定
胸腰椎骨折
Pedicle screw placement via"lordosis"of injured vertebrae
Non-bone graft fusion
Internal fixation
Thoracolumbar fracture