经皮椎弓根钉治疗胸腰椎骨折的临床研究:伤椎单双侧置钉与不置钉

Clinical studies of percutaneous pedicle screws in the treatment of thoracolumbar fractures:unilateral,bilateral screws and screw-free in the injured vertebrae

目的:探讨经皮椎弓根螺钉(Percutaneous pedicle screw fixation,PPSF)技术在胸腰段骨折椎中的三种不同处置方式对临床疗效的影响.方法:选择采用PPSF治疗的胸腰段单椎体骨折、无神经症状,且载荷评分(Load Sharing Classification,LSC)<7分的患者共计63例,依据手术方式分为跨骨折椎固定(Transvertebral fixation,TF)组18例(A组)、骨折椎单侧置钉(Unilateral pedicle screw fixation,UPSF)组24例(B组)、骨折椎双侧置钉(Bilateral pedicle screw fixation,BPSF)组21例(C组).评估手术时间、出血量、疼痛视觉模拟量表评分(Visual analog score,VAS),Oswestry功能障碍指数(Oswestry disability index,ODI),并从影像学层面评估骨折椎前缘的相对高度(Anterior height ratio of injured vertebral,AHRIV)变化情况及骨折椎在矢状面上后凸Cobb角(Cobb angle of injured vertebral,CAIV)的变化情况.结果:三组患者VAS评分在各时间点的组间比较以及ODI评分在末次随访时的组间比较均无统计学意义;手术时间方面,三组患者相互间比较其差异均有统计学意义;出血量方面,C组与A组及B组分别相比,其差异均有统计学意义;在AHRIV方面,仅在术后末次随访中可见A组与C组间比较有统计学意义,A组相较于自身术后首次复查有统计学意义;在术后CAIV丢失方面,A组的两次复查间比较有统计学意义,且A组相较B组及其与C组相比较,差异均有统计学意义.结论:使用PPSF技术治疗TLSC<7分的胸腰段单椎体骨折,行UPSF已可达到良好的复位效果,并能有效的减少骨折椎在中远期的AHRIV及CAIV的丢失,可获得较理想的临床效果.

Objective To evaluate the effect of percutaneous pedicle screw fixation(PPSF)using three different treatments on thoracolumbar fractures.Methods A total of 63 patients with single-segment thoracolumbar fractures treated with PPSF,without neurological symptoms,and with a Load sharing classification(LSC)score<7 were selected.The patients were divided into Group A(transvertebral fixation),Group B(unilateral pedicle screw fixation),and Group C(bilateral pedicle screw fixation).The clinic data of operative time,bleeding,Visual analog score(VAS),and Oswestry disability index(ODI)were assessed in the three groups.The changes of the Anterior height ratio of injured vertebral(AHRIV)and the Cobb angle of injured vertebral(CAIV)in the sagittal plane were also assessed using imaging techniques.Results There was no statistically significant difference between the three groups in terms of VAS scores at each postoperative follow-up and ODI scores at the last follow-up.In terms of operative time,the differences between the three groups were statistically significant when compared with each other.In terms of bleeding volume,the differences were statistically significant in group C compared with groups A and B,respectively.In terms of AHRIV,there was a statistically significant difference between group A and group C at the last postoperative follow-up,and there was a statistically significant difference between group A compared with its own first postoperative follow-up.In terms of postoperative CAIV loss,there was a statistically significant difference between the two follow-ups in group A,and the difference was statistically significant in group A compared with group B and with group C.Conclusion The use of PPSF for singlesegment thoracolumbar fracture with TLSC<7 has achieved good results by performing Unilateral pedicle screw fixation,and can effectively reduce loss of AHRIV and CAIV in the middle and distant stages of repositioning,which can achieve more satisfactory clinical results.