伤椎植钉曲度矫正在胸腰椎压缩骨折复位术中的临床应用

Clinical application of injured vertebral nail curvature correction to reduction of thoracolumbar compression fractures

目的比较伤椎植钉曲度矫正和常规后路钉棒复位内固定术对胸腰椎压缩骨折的治疗效果。方法 52例胸腰椎压缩骨折患者被随机分为常规组26例和实验组26例。常规组安置固定棒,常规方法撑开复位;实验组术中伤椎植钉,C臂X线机下行曲度矫正。测量和计算脊柱曲度Cobb角、椎体高度及椎间隙高度,伤椎椎体高度百分比;比较内固定系统松动及断裂情况,对脊髓损伤分级进行评估。结果术后末次随访,视觉模拟评分(VAS)评分:常规组(4.0±2.3)分,实验组(2.5±1.6)分;Oswestry功能障碍指数(ODI):常规组(32.7±16.5)分,实验组(21.4±18.4)分;Cobb角:常规组(10.2±2.7)°,实验组(7.3±2.1)°;伤椎椎体高度百分比:常规组(88.7±5.6)%,实验组(92.8±3.9)%;椎间隙高度:常规组(10.6±1.9)mm,实验组(9.5±1.4)mm。术后Frankel脊髓损伤分级:常规组A级3例,B级6例,C级9例,D级8例;实验组A级1例,B级3例,C级5例,D级7例。实验组曲度不良、背痛、椎间盘退变加速、钉道松动、钉棒系统断裂等并发症较常规组显著减少。结论胸腰椎压缩骨折钉棒复位内固定术中行伤椎植钉曲度矫正后,手术疗效较好,明显减少并发症,使患者脊髓损伤得到显著改善。

Objective To make comparison of curative effects between injured vertebral nail curvature correction and conventional posterior nail bar reset fixation on thoracolumbar compression fractures.Methods Fifty two patients with thoracolumbar compression fractures were randomly divided into conventional group（26 cases） and experimental group（26 ones）.The conventional group received the fixed bar and separabile diaplasis by the conventional method.Nails were planted in the injured vertebra of patients in the experimental group,and the curvature correction was carried out under C-arm X-ray machine.The spinal curvature Cobb angle,the vertebral body height,the distance between intervertebral spaces,and the percentage of injured vertebra height were measured and calculated.Comparison was made in the loosening and fracture of the internal fixation system,and evaluation was made in the grading of spinal cord injury.Results At the last follow-up after the operation,the visual simulation scores of the conventional group was 4.0 ± 2.3,while that of the experimental group was 2.5 ± 1.6.Oswestry dysfunction indexes of the conventional and the experimental group were 32.7 ± 16.5 and 21.4 ± 18.4,respectively;The Cobb angles of the two groups were（10.2 ± 2.7） ° and（7.3 ± 2.1） °,respectively.The percentages of injured vertebra height in two groups were（88.7 ± 5.6） % and（92.8 ± 3.9） %,respectively.The distance between the intervertebral space of the two groups was（10.6 ± 1.9） mm and（9.5 ± 1.4） mm,respectively.According to the postoperative Frankel gradings of spinal cord injury,there were 3 cases belonging to grade A,6 ones to grade B,9 ones to grade C,and 8 ones to grade D in the conventional group;there was one case to grade A and 3 cases to grade B,5 ones to grade C,and 7 ones to grade D in the experimental group.The incidence of complications,such as bad curvature,back pain,disc accelerated degeneration,screw channel loosening,and the fracture of screw rod system was significantly lower in the experimental group than those in the conventional group.Conclusion Application of injured vertebral nail curvature correction to reduction of thoracolumbar compression fractures achieves good operative effects and obviously reduces the incidence of complications,which significantly improve the patients＇ spinal cord injury.