经伤椎置钉短节段固定治疗腰椎骨折的疗效评价和安全性分析

The evaluation and safety analysis of the treatment of lumbar fracture with vertebral short segment fixation

目的探讨经伤椎置钉短节段固定对腰椎骨折的治疗效果,并分析术后并发症情况。方法回顾性分析2010年10月—2015年10月在乐山市中医院骨科接受治疗的100例腰椎骨折患者的临床资料,根据其手术方式分为经伤椎短节段固定组和跨伤椎短节段固定组。其中经伤椎短节段固定组45例,男性25例,女性20例;年龄28~63岁,平均40.1岁。致伤原因:道路交通伤30例,高处坠落伤15例。骨折部位L_(1~5)。跨伤椎短节段固定组55例,男性32例,女性23例;年龄26~65岁,平均40.1岁。致伤原因:道路交通伤38例,高处坠落伤17例。骨折部位L_(1~5)。观察两组手术一般情况,比较两组术后恢复情况和生活质量情况。结果经伤椎短节段固定组的手术时间(188.9±18.0)min,术后住院时间(12.1±1.6)d,较跨伤椎短节段固定组长[(160.1±20.1)min,(9.3±1.0)d],术中出血量(312.5±9.3)mL,较跨伤椎短节段固定组[(285.2±10.2)mL]多(P<0.05);两组术前椎体前缘压缩度和后凸Cobb角差异无统计学意义,术后6个月,经伤椎短节段固定组的椎体前缘压缩度(45.1±5.9)%,后凸Cobb角(25.7±3.7)°,低于跨伤椎短节段固定组[(45.1±6.2)%,(25.7±4.1)°]。术前两组患者血清磷酸肌酸激酶水平差异无统计学意义,经伤椎短节段固定组患者术后1、3、7d的磷酸肌酸激酶水平低于跨伤椎短节段固定组;两组患者手术前生活质量得分差异无统计学意义,术后6个月时,经伤椎短节段固定组的生活质量高于跨伤椎短节段固定组。结论经伤椎置钉短节段固定虽然手术时间长,但对腰椎骨折有较好的手术效果,对椎旁骨骼肌损伤小,具有临床推广应用的价值。

Objective To investigate the therapeutic effect of the short segment fixation of the injured vertebra on the fracture of the lumbar spine,and to analyze the postoperative complications.Methods The clinical data of patients with lumbar fracture treated in Department of Orthopedics,Leshan Hospital of Traditional Chinese Medicine from Oct.2010 to Oct.2015 were retrospectively analyzed.According to their operative methods,they were divided into vertebral short segment fixation group and short segment fixation across the injured vertebra group.The general conditions of the two groups were observed,and the recovery and quality of life were compared between the two groups.Results The operation time of vertebral short segment fixation group was(188.9±18)minutes,postoperative hospitalization time was(12.1±1.6)days,which was more than short segment fixation across the injured vertebra group((160.1±20.1)minutes,(9.3±1)day).Bleeding volume was(312.5±9.3)mL in the vertebral fixation group and short segment across the injured vertebra group((285.2±10.2)mL,P<0.05).The preoperative vertebral compression rate and kyphosis Cobb s angle difference of the two groups were not statistically significantly different.Six months after surgery,anterior vertebral compression of the vertebral short segment fixation group was(45.1±5.9)%,kyphosis Cobb s angle was(25.7±3.7)°,which were lower than those in the short segment fixation across the injured vertebra group((45.1±6.2)%,(25.7±4.1)°).There was no significant difference in serum creatine kinase level between the two groups before operation.The levels of creatine kinase 1,3 and 7day after operation were lower in the vertebral short segment fixation group than those in the short segment fixation across the injured vertebra group.There was no statistically significant difference in quality of life between the two groups before surgery.At 6 months after operation,the quality of life in the short segment fixation group was higher than that in the short segment fixation across the injured vertebra group.Conclusion Vertebral short segment fixation is a good operative procedure for lumbar fractures,though it has longer operation time.It has little damage to paraspinal skeletal muscle and is worthy of clinical application.