经伤椎固定修复胸腰段椎体骨折对脊柱稳定性及修复后腰背痛的影响

Effect of vertebral pedicle screw fixation on the spinal stability and low back pain in the treatment of thoracolumbar fracture

目的探讨经伤椎固定修复胸腰段椎体骨折对脊柱稳定性及修复后腰背痛的影响。方法选取2015年5月~2017年12月我院骨科胸腰椎压缩性骨折患者75例为研究对象,根据内固定方式分为观察组(n=34)和对照组(n=41),观察组采用经伤椎固定,而对照组采用跨伤椎固定。比较两组患者的修复效果、伤椎前缘高度、后凸Cobb角及视觉模拟评分法(VAS)。结果两组患者的椎体前缘高度比值和后凸Cobb角在治疗前后及修复矫正方面比较,差异无统计学意义(P>0.05),而观察组的椎体前缘高度比值和后凸Cobb角在末次随访中均优于对照组(P<0.05)。治疗前后,两组患者VAS评分组间比较,差异无统计学意义(P>0.05);而观察组末次随访时的VAS评分优于观察组(P<0.05);组内比较中,治疗前后的VAS评分、治疗前和末次随访的VAS评分、治疗后和末次随访的VAS评分比较,两组差异均有统计学意义(均P<0.05)。所有研究对象中12例患者出现了并发症,发生率为16.00%。结论经伤椎固定在维持脊柱高度和曲度方面优势更明显,更有利于脊柱的稳定性,能有效控制修复后腰背痛。

Objective To investigate the effect of vertebral pedicle screw fixation on the spinal stability and low back pain in the treatment of thoracolumbar fracture. Methods75 patients with thoracolumbar vertebral compression fractures in department of orthopedics of our hospital from May 2015 to May 2018 were selected and divided into two groups according to the internal fixation method. 41 patients in the control group were treated with inter-vertebral screw fixation, while 34 patients in the observation group received the vertebral pedicle screw fixation. Then the repair effect, anterior vertebral height, the Cobb angle, and the visual analog scale (VAS) score were compared between the two groups. ResultsThe pre-treatment and post-treatment anterior vertebral height, the Cobb angle and the repair effect had no difference between groups ( P >0.05), while the anterior vertebral height and the Cobb angle of the observation group were better than those of the control group during the last follow-up ( P <0.05). The pre-treatment and post-treatment VAS score had no difference before treatment ( P >0.05);The VAS score of pretreatment and last follow-up as well as the post-treatment and last follow-up within groups had statistic difference ( P <0.05). The total incidence rate of the complications was 14.08%(10 cases). ConclusionThe application of the vertebral pedicle screw fixation has the dominance in maintaining the height and curvature of the spine, and is more effective in the stability reconstruction and the low back pain control.