椎弓根螺钉内固定术治疗胸腰段B2型骨折手术效果及术后矫正丢失分析

Surgical effect and postoperative correction loss analysis of pedicle screw internal fixation in the treatment of thoracolumbar B2 fractures

目的探讨椎弓根螺钉内固定术治疗胸腰段B2型骨折手术效果并分析术后矫正丢失原因。方法纳入2014-04-2016-04于我院治疗的72例胸腰段B2型骨折患者,均采用椎弓根螺钉内固定术治疗,其中42例采用经皮椎弓根螺钉内固定术治疗,设为A组;30例采用开放手术行椎弓根螺钉内固定术,设为B组。比较两组手术前后的相关指标,并分析术后矫正丢失的原因。结果A组患者住院时间、手术时间、出血量均显著低于B组,住院费用显著高于B组,差异有统计学意义(P<0.05);两组手术后ODI评分、VAS评分均显著降低、伤椎椎体前缘高度比显著升高(P<0.05),末次随访时组间差异无统计学意义(P>0.05);两组术后Cobb角均显著降低,末次随访显著高于术后即刻,差异具有统计学意义(P<0.05),但组间Cobb角丢失差异无统计学意义(P>0.05)。植骨量、螺钉进入椎体距离、开始锻炼时间、术后椎间隙塌陷的不同,对术后Cobb角丢失具有显著影响(P<0.05)。结论开放与经皮椎弓根螺钉内固定术治疗胸腰段B2型骨折,均能有效提升椎体高度与腰椎功能、减轻疼痛,但前者创伤更小,不同植骨量、螺钉进入椎体距离、开始锻炼时间、术后椎间隙塌陷情况,均可造成术后矫正丢失。

Objective To investigate the effect of pedicle screw internal fixation in the treatment of thoracolumbar B2 fractures and to analyze the causes of postoperative correction loss. Methods A total of 72 patients with thoracolumbar B2 fractures treated in our hospital from April 2014 to April 2016 were selected. All patients were treated with pedicle screw fixation. A retrospective analysis of the medical records was performed. Forty-two cases were treated with percutaneous pedicle screw fixation(group A), and 30 cases were treated with open surgery and pedicle screw fixation(group B). The indicators of operation and hospitalization were compared between the two groups. After follow-up for 2 years, the lumbar Oswestry dysfunction index (ODI), visual analog pain (VAS) score and the height ratio of the vertebral anterior were compared before and after treatment. The Cobb angle at the last follow-up was recorded and the loss of Cobb angle was calculated. The cause of postoperative correction loss was analyzed. Results The time of hospitalization, operation time and blood loss in group A were significantly lower than those in group B, and the hospitalization cost in group A was significantly higher than that in group B, the differences were statistically significant(P<0.05). The ODI score and VAS score in both two groups reduced significantly after surgery. The height ratio of the vertebral anterior edge of the injured vertebral significantly increased, and the differences were statistically significant (P<0.05). There was no significant difference in the final follow-up (P>0.05). The Cobb angle in the two groups significantly decreased, and the Cobb angle at the last follow-up was significantly higher than immediate postoperation, and the difference was statistically significant (P<0.05). There was no significant difference in the loss of Cobb angle between the two groups (P>0.05). The differences of amount of bone graft, the distance from the screw into the vertebral body, the start of exercise time and loss of Cobb angle in patients with posterior intervertebral space collapse were statistically significant (P<0.05). Conclusion Open and percutaneous pedicle screw fixation in the treatment of thoracolumbar B2 fractures can effectively increase the height of the vertebral body and lumbar function and reduce the pain symptom. But the former has less trauma. The different bone graft volume, screws into the vertebral body distance, starting exercise time, and postoperative intervertebral space collapse can cause postoperative correction loss.