胸腰椎爆裂性骨折术后并发症原因分析

Analysis of the causes of complications after internal fixation for thoracolumbar burst fracture

目的探讨不同手术方法胸腰椎爆裂性骨折内固定的治疗效果与并发症情况。方法 2014年7月—2016年2月湖北医药学院附属东风医院诊治的胸腰椎爆裂性骨折患者94例,根据治疗方法不同分为观察组与对照组(各47例),对照组男性27例,女性20例,平均年龄(56.33±2.94)岁;观察组男性25例,女性22例,平均年龄(56.13±3.24)岁;对照组选择后路短节段椎弓根钉内固定治疗,观察组采用钉棒系统内固定+植骨成形+后外侧植骨治疗,记录两组术后并发症发生情况与预后恢复情况。结果全部患者均已完成手术,且两组患者在手术时间上没有显著差异,但是在住院时间与术中出血量方面,观察组比对照组明显要少。术后1个月,观察组切口感染、植入物断裂、肺部感染、植入物松动等并发症发生率为4.3%,对照组为21.3%,观察组明显少于对照组(χ2=2.781,P<0.05),所有并发症均进行对症处理后好转。观察组与对照组术后1个月的神经功能评分分别为(6.13±0.78)分和(5.09±0.71)分,均明显高于术前的(2.87±0.67)分和(2.81±0.71)分(P<0.05),且观察组术后1个月神经功能评分明显高于对照组(P<0.05)。观察组与对照组术后1个月的伤椎体Cobb角均明显低于术前(P<0.05),同时观察组术后1个月的伤椎体Cobb角也明显低于对照组(P<0.05)。结论胸腰椎爆裂性骨折内固定术后并发症比较常见,钉棒系统内固定+植骨成形+后外侧植骨治疗的应用能减少并发症的发生,促进术后神经功能与伤椎体Cobb角的恢复,从而促进患者康复。

Objective To investigate the effect and complication of different surgical methods in the treatment of thoracolumbar burst fracture. Methods A total of 94 patients with thoracolumbar burst fractures who were treated in our hospital from Jul. 2014 to Feb. 2016 were divided into observation group and control group according to different treatment methods,with 47 cases in each group. In the control group,there were 27 males and 20 females,with an average age of（ 56. 33 ± 2. 94） years; in the observation group there were 25 males and 22 females,with an average age of（ 56. 13 ± 3. 24） years. The control group was treated with posterior short-segment pedicle screw fixation; and the observation group was fixed with screw rod system. ＋ bone grafting ＋ posterolateral bone grafting. The postoperative complications and prognosis of the two groups were recorded. Results All patients had completed the surgery,and there was no significant difference in the operation time between the two groups. However,in the hospitalization time and intraoperative blood loss,the observation group was significantly less than the control group. At 1 month after surgery,the incidence of complications such as incision infection,implant breakage,lung infection,and implant loosening was 4. 3% in the observation group and 21. 3% in the control group.The observation group was significantly less than the control group（ χ2= 2. 781,P 0. 05）. All complications improved after symptomatic treatment. The neurological function scores of the observation group and control group at one month after operation were（ 6. 13 ± 0. 78） points and（ 5. 09 ± 0. 71） points,respectively,which were significantly higher than preoperatively（（ 2. 87 ± 0. 67） points and（ 2. 81 ± 0. 71） points）（ P 0. 05）. The neurological function score in the observation group was significantly higher than that in the control group at 1 month after surgery（ P 0. 05）. The Cobb angles of the injured vertebral body in the observation group and the control group at one month after operation were significantly lower than preoperatively（ P 0. 05）. The Cobb angle of the injured vertebral body in the observation group at 1 month after the operation was also significantly lower than that in the control group.（ P 0. 05）. Conclusion The complications of internal fixation in treating thoracolumbar burst fracture are common. The application of internal fixation with screw system,bone grafting and posterolateral bone graft can reduce the occurrence of complications,and promote recovery of postoperative neurological function and Cobb angle of the injured vertebral body,thus promoting the recovery of patients.