后路内固定术中分步体内原位弯棒复位技术治疗腰椎爆裂骨折的效果

Application of step-by-step in situ rod bending in posterior internal fixation of lumbar burst fractures

目的探讨后路内固定术中应用分步体内原位弯棒复位技术治疗腰椎爆裂骨折的临床疗效。方法采用回顾性病例对照研究分析2007年3月-2014年3月收治的76例腰椎爆裂骨折患者，其中男48例，女28例；年龄18～57岁，平均40．4岁。损伤节段：L1 32例，L2 24例，L3 14例，L4 6例。根据术中弯棒方法不同分为两组，其中34例采用体外预弯棒技术（体外预弯棒组），42例采用体内原位弯棒技术（体内原位弯棒组）。比较两组手术时间、术中出血量、术后引流量、术后伤椎前缘高度恢复及后凸Cobb角恢复情况、术前和术后疼痛视觉模拟评分（VAS）。结果76例患者获随访12～36个月，平均20．9个月。其中体外预弯棒组1例发生内固定松动，于术后9个月拆除内固定，余无内固定断裂发生。体外预弯棒组与体内原位弯棒组手术时间分别为（88．1±16．0）min和（79．9±14．7）min（P〈0．05），术中出血量分别为（88．3±21．2）ml和（74．0±12．5）ml（P〈0．01），术后引流量分别为（71．5±17．3）ml和（62．1±16．0）ml（P〈0．05），术后伤椎前缘高度分别恢复（74．1±7．8）％和（79．5±8．5）％（P〈0．01），后凸Cobb角分别恢复至（10．2±2．7）°和（8．8±2．6）°（P〈0．01）。体外预弯棒组与体内原位弯棒组术前VAS分别为（7．5±0．9）分和（7．2±1．0）分（P〉0．05），术后1周VAS分别为（2．9±0．7）分和（3．0±0．7）分（P〉0．05），术后9个月VAS分别为（2．2±0．7）分和（1．9±0．7）分（P〈0．01）。结论与体外预弯棒技术相比，后路内固定术中应用分步体内原位弯棒技术治疗腰椎爆裂骨折具有手术时间短、出血少、精准复位及有效减少中远期腰背痛等优点。

Objective To evaluate the clinical outcome of the technique of step-by-step in situ rod bending used in posterior internal fixation of lumbar burst fractures. Methods A retrospective case control analysis was conducted on 76 cases of lumbar burst fractures hospitalized between March 2007 and March 2014. There were 48 males and 28 females, with a mean age of 40.4 years （ range, 18-57 years）. Fractured segments included L1 in 32 cases, L2 in 24, L3 in 14 and L4 in 6. According to the different rod bending methods, the subjects were divided into preliminary rod bending group （34 cases） and in suit rod bending group （42 cases）. Operation time, amount of bleeding during and after operation, restoration of anterior vertebral height and Cobb angle, and visual analogue score （VAS） were compared between groups. Results Seventy patients were followed up for 12-36 months （mean, 20. 9 months）. One patient in preliminary rod bending group presented internal fixation loosening, and had implant removal 9 months after operation. No implant breakage occurred. Comparison of preliminary rod bending group and in situ rod bending group showed significant differences in operation time [ （88.1 ± 16.0）rain vs. （ 79.9 ± 14.7）mini, amount of bleeding during operation [ （88.3 ± 21.2） ml vs. （74.0 ± 12.5） ml ], amount of bleeding after operation [ （71.5 ±17.3）ml vs. （62. 1 ± 16.0）ml] , restoration of anterior vertebral height [ （74. 1 ± 7.8）% vs.（79.5±8.5）%], and restoration of Cobb angle [ （10.2±2.7） °vs. （8.8±2.6） °]（P〈 0.01 or 0.05 ）. VAS presented no significant differences between preliminary rod bending group and in situ rod bending group before operation [ （7.5 ± 0.9） points vs. （ 7.2 ± 1.0） points ] and 1 week after operation [ （ 2.9 ± 0.7 ） points vs. （ 3.0 ± 0.7 ） points ] （ P 〉 0.05 ） , while there was significant difference 9 months after operation [ 2.2 ± 0.7 ） points vs. （ 1.9 ± 0.7 ） points ] （ P 〈 0.01 ）. Conclusion In suit rod bending for lumbar burst fractures has advantages over preliminary rod bending in terms of operation time, blood loss, precise restoration and back pain.