A型胸腰段骨折伤椎稳定区置钉的方法与疗效评价

METHODS FOR MONO-SEGMENT PEDICLE INSTRUMENTATION IN THE STABLE AREA OF FRACTURED VERTEBRA AND THEIR CLINICAL EFFECTS IN PATIENTS WITH TYPE A THORACOLUMBAR FRACTURE

目的提出伤椎稳定区置钉单节段固定治疗A型胸腰段骨折的方法,评价伤椎稳定区置钉的安全性、准确性及临床疗效。方法 2013年10月—2016年12月,采用后路经Quadrant通道伤椎稳定区置钉单节段复位内固定治疗无神经损伤的A型胸腰段骨折112例。采用疼痛视觉模拟评分法(VAS)评分及Oswestry功能障碍指数(ODI)评价临床疗效;对比手术前后及末次随访时伤椎前缘高度压缩率及伤椎Cobb角评价复位效能;术后在CT图像上,按伤椎稳定区判定方法评价伤椎螺钉在椎体内的区域位置;按Andrew分级标准判定常规置钉方法及稳定区置钉方法准确性。结果末次随访时疼痛VAS评分及ODI均较术前显著改善(t=25.950、31.770,P<0.01)。术前伤椎前缘高度压缩率为(31.2±17.2)%,术后3d及末次随访时分别为(9.4±4.2)%、(10.3±3.7)%,手术前后差异有统计学意义(t=17.572、17.440,P<0.01);术前伤椎矢状位Cobb角为17.2°±2.1°,术后3d及末次随访时分别为6.2°±0.7°、6.7°±0.6°,手术前后差异有统计学意义(t=25.012、25.780,P<0.01)。术后按照稳定区判定方法判定术后伤椎螺钉优良率为100%。按照Andrew分级常规方法螺钉优良率为96.4%,稳定区置钉方法螺钉优良率为95.5%,差异无统计学意义(P>0.05)。结论经扩张通道伤椎稳定区置钉单节段固定治疗A型胸腰段骨折安全可行,伤椎稳定区置钉安全性和准确性与传统置钉方式相似,临床效果满意。

Objective To investigate the methods for mono-segment pedicle instrumentation in the stable area of fractured vertebra in patients with type A thoracolumbar fracture and their safety, accuracy, and clinical effects. Methods A total of 112 patients with type A thoracolumbar fracture who were treated by mono-segment pedicle instrumentation in the stable area of fractured vertebra via the posterior approach through the Quadrant invasive system from October 2013 to December 2016 and had no nerve injury were enrolled. The Visual Analogue Scale （VAS） score and the Oswestry Disability Index （ODI） were used to evaluate the clinical outcome. The anterior vertebral compression ratio and the Cobb angle of the fractured vertebra were measured before and after surgery and at final follow-up to evaluate the efficiency of reduction. After surgery, the position of pedicle screw was evaluated on CT image according to the method for determining the stable area of the fractured vertebra, and the Andrew grading method was used to evaluate the accuracy of conventional screw placement methods and methods for screw placement in the stable area. Results There were significant improvements in VAS score and ODI at the final follow-up （ t =25.950 and 31.770, P 〈 0.01 ）. The anterior vertebral compression ratio was （31.2±17.2）% before surgery, （9.4±4.2）% on day 3 after surgery, and （10.3 ±3.7）% at the final follow-up, and there were significant changes after treatment （ t =17.572 and 17.440, P 〈0.01）. The sagittal Cobb angle was 17.2°±2.1° before surgery, 6.2°±0.7° on day 3 after surgery, and 6.7°±0.6° at the final follow-up, and there were significant changes after treatment （ t =25.012 and 25.780, P 〈0.01）. According to the method for determining stable area, the excellent and good rate of pedicle screw in the fractured vertebra was 100%. According to the Andrew grading method, the excellent and good rate of pedicle screw placed using conventional methods was 96.4%, while the excellent and good rate of pedicle screw placement in stable area was 95.5%; there was no significant difference （ P 〉0.05）. Conclusion Mono-segment pedicle instrumentation in the stable area of fractured vertebra is safe and feasible in the treatment of type A thoracolumbar fracture and has similar safety and accuracy to conventional screw placement methods and a satisfactory clinical effect.