内固定拆除前胸腰椎骨折病例矫正曲度丢失的相关因素分析

Analyzing Risk Factors that were Associated with Loss of Correction Curvature after Short-segment Restoration and Fixation in Cases Who had Single-segment Thoracolumbar Fracture

目的:分析后路短节段复位内固定拆除前的胸腰椎单节段骨折病例矫正曲度丢失的相关因素。方法:纳入于2008.01-2011.01间因胸腰椎单节段骨折于我科接受短节段复位内固定术、影像学资料完整的患者共计87例。于术前、术后及拆除内固定前的胸腰椎侧位X线片上测量伤椎上位椎体和下位椎体所成的Cobb角(α角)、伤椎上终板和上位椎体所成角度(即β角)、伤椎下终板和下位椎体所成角度(γ角)以及伤椎上下终板所成的角度(δ角)。以T检验比较各测量角及改变量,并对α角改变量和各因素进行相关性分析。结果:与术前相比,术后的α角、β角、γ角和δ角均显著增加(p<0.05);和术后相比,拆除内固定前α角和δ角均明显减少(p<0.05),α角的平均改变量为-2.85度。将α角改变量和各因素进行相关性分析后发现,α角改变量和手术前后矫正曲度(相关系数:-0.342,p=0.026)呈显著负相关,和终板破坏部位(相关系数:0.374,p=0.015)、δ角改变量呈显著正相关(相关系数:0.231,p=0.041)。结论:接受短节段复位内固定的胸腰椎骨折病例内固定拆除前矫正曲度有明显丢失,术后矫正曲度、终板损伤部位和伤椎上下终板所成角度改变量与矫正曲度的丢失有明显相关性。

Objective：To analyze risk factors that were associated with loss of correction curvature after short-segment restoration and fixation in cases who had single-segment thoracolumbar fracture.Methods：87 Cases who had experienced single-segment thoracolumbar fracture and had underwent short-segment restoration and fixation in our department from Jan 2008 to Jan 2011,and had complete follow-up imaging were included.Cobb angles were measured on lateral thoracolumbar X-ray preoperatively,postoperatively and before removal of internal fixation.And these included the angle formed by vertebras that located above and below injured vertebrae（α angle）,superior endplate of injured vertebrae and its superior vertebrae（β angle）,inferior endplate of injured vertebrae and its inferior vertebrae（γ angle）,inferior and superior endplate of injured vertebrae（δ angle）.T-test was used to analyze these angles and their changes.And correlation analysis was used to analyze relationships between α angle change and other risk factors.Results：When compared with preoperative angles,the mean α angle,β angle,γ angle and δ angle were all significantly increased（p〈0.05） after the operation.The meanα angle and δ angle before the removal of internal fixation were both significantly smaller than those after the operation（p〈0.05）,and the mean change of α angle was-2.85 degrees.After the correlation analysis,we found significant correlations between the change of α angle and postoperative correction curvature（-0.342,p=0.026）,injured region in endplate（0.374,p=0.015）,and change of the δ angle（0.231,p=0.041）.Conclusion：There was significant loss in the correction curvature before the removal of internal fixation.And the loss was significantly associated with postoperative correction curvature,injured region in endplate,and change of the δ angle.