改良技术在陈旧性胸腰椎骨折中的应用及对邻近椎间盘形态的影响

APPLICATION OF IMPROVED PSO TECHNOLOGY IN OLD THORACOLUMBAR FRACTURES AND ITS EFFECT ON SHAPE OF ADJACENT DISCS

目的探讨改良经椎弓根椎体截骨术(PSO)在治疗陈旧性胸腰椎骨折中的效果及对邻近椎间盘形态的影响。方法选取2014年3月—2018年6月重庆医药高等专科学校附属第一医院骨科治疗的113例陈旧性胸腰椎骨折患者为研究对象进行回顾性分析,根据手术方法分组,56例患者采用传统PSO技术治疗为传统组,57例患者接受改良的PSO技术治疗为改良组;统计分析二组的手术时间、出血量、术后不同时间的脊柱Cobb角、日本骨科协会(JOA)评分的变化,相邻头侧椎间盘的Oner形态学改变分度变化。结果手术时间、出血量二组之间比较,改良组均低于传统组,差异均有统计学意义(均P<0.05);术前,改良组和传统组的Cobb角差异无统计学意义(P>0.05);术后1周、术后3个月、术后6个月,改良组的Cobb角均低于传统组,差异均有统计学意义(均P<0.05);改良组和传统组患者术前至术后6个月的JOA评分差异均无统计学意义(均P>0.05);术前、术后6个月,改良组和传统组的头侧椎间盘的Oner形态分布比较,差异均无统计学意义(均P>0.05);术后改良组的手术并发症发生率5.36%低于传统组的19.30%(P<0.05)。结论改良的PSO技术治疗陈旧性胸腰椎骨折较传统手术具有创伤更小、操作简单、术后Cobb角恢复更好、并发症更少的优势,对头侧椎间盘形态的改善效果与传统手术相当。

Objective To explore the effect of modified transpedicular vertebral osteotomy(PSO)in the treatment of old thoracolumbar fractures and the influence on the shape of adjacent discs.Methods From March 2014 to June 2018,one hundred and thirteen patients with old thoracolumbar fractures treated by the Department of Orthopedics of the First Affiliated Hospital of Chongqing Medical College were selected as the research objects for retrospective analysis and grouped according to surgical methods.Fifty-six patients treated with traditional PSO technology were treated as the traditional group,and 57 patients treated with modified PSO technology were treated as the modified group;The operation time,blood loss,Cobb angle of the spine at different times after the operation,changes in the scores of the Japanese Orthopaedic Association(JOA),and the Oner morphological changes of the adjacent cephalic intervertebral discs were statistically analyzed.Results Compared with the traditional group,the improvement group was lower than that of the traditional group(P<0.05).Before surgery,the difference in Cobb angle between the modified group and the traditional group was no statistically significant(P>0.05);The Cobb angle of the modified group was lower than that of the traditional group at 1 week,3 months,and 6 months after surgery,the differences were all statistically significant(P<0.05);the JOA scores of the patients in the modified group and the traditional group before surgery to 6 months after surgery The differences were not statistically significant(P>0.05),;the Oner morphological distribution of the cephalic discs in the modified group and the traditional group was not statistically significant(P>0.05);Postoperative observation showed that the complication rate in the modified group was 5.36%lower than the traditional group’s 19.30%(P<0.05).Conclusion The improved PSO technique has the advantages of less trauma,simple operation,better postoperative Cobb angle recovery,and fewer complications than traditional surgery.The effect of improving the morphology of the intervertebral disc of the head is equivalent to that of traditional surgery.