经伤椎置入万向螺钉内固定对胸腰段脊柱骨折椎体参数、机体应激及功能恢复的影响

Effects of Internal Fixation with Universal Screw Placement through Injured Vertebrae on Vertebral Parameters,Body's Stress and Functional Recovery of Patients with Thoracolumbar Spine Fractures

目的探究经伤椎置入万向螺钉内固定对胸腰段脊柱骨折的治疗效果。方法回顾性分析2013年6月—2020年4月收治的胸腰椎单节段椎体骨折患者的临床资料。从采用经伤椎椎弓根6钉内固定术治疗的患者中选取51例作为经伤椎固定组,从采用跨伤椎椎弓根4钉内固定术治疗的患者中选取51例作为跨伤椎固定组。比较2组围术期指标和术前、术后3个月及术后1年时椎体参数;观察2组术前、术后2 h血清肾上腺素(E)、皮质醇(Cor)、去甲肾上腺素(NE)变化情况;评估2组术后1年腰椎疼痛程度和功能恢复状况。结果经伤椎固定组手术时间长于跨伤椎固定组,卧床时间短于跨伤椎固定组(P<0.05)。术后3个月及术后1年时,2组矢状面Cobb角及椎体高度压缩率较术前减小,伤椎前缘高度比较术前升高(P<0.05);术后1年,2组矢状面Cobb角和椎体高度压缩率大于术后3个月,伤椎前缘高度比低于术后3个月(P<0.05);术后1年,经伤椎固定组矢状面Cobb角及椎体高度压缩率小于跨伤椎固定组,伤椎前缘高度比高于跨伤椎固定组(P<0.05)。术后2 h,2组血清E、Cor、NE水平较术前明显升高,且跨伤椎固定组Cor水平高于经伤椎固定组(P<0.05)。经伤椎固定组术后1年视觉模拟评分法评分及Oswestry功能障碍指数低于跨伤椎固定组(P<0.05)。结论经伤椎椎弓根6钉内固定治疗与跨伤椎椎弓根4钉内固定治疗均可有效矫正患者胸腰椎单节段骨折椎体畸形,恢复脊柱生物学结构。临床根据患者的椎弓根损伤情况、椎管占位程度等综合条件灵活选择术式。

Objective To explore the therapeutic effect of internal fixation with universal screw placement through injured vertebrae on patients with thoracolumbar spine fractures.Methods Clinical data of patients with single-segment thoracolumbar vertebral fractures who had been admitted between June 2013 and April 2020 was retrospectively analyzed.Of them,51 patients were randomly selected from the patients treated with pedicular fixation with 6 screws through injured vertebrae as fixation through injured vertebrae group,and 51 patients were randomly selected from the patients treated with pedicular fixation with 4 screws across injured vertebrae as fixation across injured vertebrae group.The perioperative indicators,and vertebral body parameters before and after surgery for 3 months and 1 year were compared between two groups.Changes of serum epinephrine(E),cortisol(Cor)and norepinephrine(NE)before and after surgery for 2h were compared between two groups.The degree of lumbar pain and functional recovery were evaluated after operation for 1 year in two groups.Results Compared with those in fixation across injured vertebrae group,operative duration was significantly longer,while the time of lying in bed was significantly shorter in fixation through injured vertebrae group(P<0.05).After operation for 3 months and 1 year,values of sagittal plane Cobb angle and compression rates of vertebral body height were significantly decreased,while height ratios of anterior edge of injured vertebral body were significantly increased compared with those before operation in two groups(P<0.05).After operation for 1 year,values of sagittal plane Cobb angle and compression rates of vertebral body height were significantly increased,while height ratios of anterior edge of injured vertebral body were significantly decreased compared with those after operation for 3 months(P<0.05).Compared with those in fixation across injured vertebrae group,after operation for 1 year,values of sagittal plane Cobb angle and compression rate of vertebral body height were significantly decreased,while the height ratio of the anterior edge of the injured vertebral body was significantly increased in fixation through injured vertebrae group(P<0.05).After operation for 2 h,serum levels of E,Cor and NE were significantly higher than those before operation in two groups,and the Cor level in fixation across injured vertebrae group was significantly higher than that in fixation through injured vertebrae group(P<0.05).Visual analogue scale(VAS)score and Oswestry dysfunction index(ODI)after operation for 1 year in fixation through injured vertebrae group were significantly lower than those in fixation across injured vertebrae group(P<0.05).Conclusion Both pedicular fixation with 6 screws through injured vertebrae and pedicular fixation with 4 screws across injured vertebrae may effectively correct the single-segment vertebral deformity and restore the biological structure of the spine.It is recommended to choose the surgical method flexibly according to the comprehensive conditions of the patients such as pedicle injury and the degree of spinal canal occupation.