经伤椎短节段内固定术后再发后凸畸形的危险因素研究

Study on risk factors of kyphosis after injured vertebrae short segmental internal fixation

目的研究胸腰椎爆裂性骨折经伤椎短节段内固定术后再发后凸畸形的危险因素。方法纳入2011年3月~2016年3月于本院治疗的224例胸腰椎爆裂性骨折患者,均采用经伤椎短节段内固定治疗,随访3年以上,将末次随访Cobb角丢失≥5°以及<5°者分别设为观察组与对照组。调查两组患者病历资料,并经单因素分析以及Logistic回归分析调查术后再发后凸畸形的危险因素。结果224例患者术后再发后凸畸形40例,发生率17.86%,平均丢失角度(7.02±1.21)°;两组年龄、伤椎前缘高度比(anterior vertebra height ratio,AVH)、伤椎植骨、后凸Cobb角(Cobb angle,CA)、功能锻炼、体质量指数(body mass index,BMI)差异有统计学意义(P<0.05);Logistic回归分析显示,AVH<50%(OR=2.811)、伤椎未植骨(OR=2.322)、功能锻炼不合理(OR=2.130)、CA>30°(OR=2.785)、年龄>60岁(OR=2.105)是胸腰椎爆裂性骨折经伤椎短节段内固定术后再发后凸畸形的独立危险因素。结论胸腰椎爆裂性骨折经伤椎短节段内固定术后易再发后凸畸形,受到AVH、伤椎植骨、CA、功能锻炼、年龄等多种因素影响。

Objective To study the risk factors of kyphosis after thoracolumbar burst fractures of injured vertebrae short segmental internal fixation.Methods A total of 224 patients with thoracolumbar burst fractures treated in our hospital from March 2011 to March 2016 were selected.All patients were treated with short-segment internal fixation of injured vertebrae,and followed up for more than 3 years.The patients with Cobb angle loss≥5°and<5°at the last follow-up were set as the observation group and the control group,respectively.The medical records of the two groups were investigated,and the risk factors of kyphosis after surgery were analyzed by univariate analysis and logistic regression analysis.Results In 224 patients,40 cases recurred kyphosis,the incidence rate was 17.86%,and the average loss angle was(7.02±1.21)°.There were significant differences in age,anterior vertebral height ratio(AVH),bone graft,Cobb angle(CA),functional exercise and body mass index(BMI)between the two groups(P<0.05).Logistic regression analysis showed that AVH<50%(OR=2.811),injured vertebrae without bone grafting(OR=2.322),unreasonable functional exercise(OR=2.130),RA>30°(OR=2.785),age>60 years old(OR=2.105)were independent risk factors for kyphosis after injured vertebrae short-segmental fixation of thoracolumbar burst fractures.Conclusion The kyphosis is easily recurrent after injured vertebrae short segmental fixation of thoracolumbar burst fractures,which is affected by various factors such as AVH,injured bone graft,CA,functional exercise and age.