经皮跨伤椎与经伤椎短节段后路内固定治疗胸腰椎骨折的临床疗效及力学性能比较

Clinical efficacy and mechanical properties comparison between percutaneous trans-traumatic and trans-traumatic short-segment posterior internal fixation for thoracolumbar fractures

目的分析比较经皮跨伤椎与经伤椎短节段后路内固定治疗胸腰椎骨折的临床疗效及力学性能。方法选取2017年3月—2018年3月新疆医科大学附属中医医院收治的胸腰段骨折患者35例,依据患者意愿,采用经皮跨伤椎或经伤椎短节段后路内固定术治疗,并分为A组(17例)、B组(18例)。随访12个月,比较两组的手术指标:手术时间、失血量、切口长度,术前、术后1周及末次随访力学性能指标:后凸Cobb角、骨折椎前缘高度比,术前、末次随访的临床效果指标:疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)。评价两组手术治疗的安全性。结果两组比较,B组的手术时间较长、失血量较多、切口也较长(P<0.05);两组手术后的后凸Cobb角和骨折椎前缘高度比均较术前改善(P<0.05);术前与术后1周两组的力学性能比较,差异无统计学意义(P>0.05);末次随访时,B组的力学性能优于A组(P<0.05);至末次随访,两组的VAS评分、ODI均下降(P<0.05),其中B组低于A组;此外A组VAS评分差值及ODI差值较B组低(P<0.05)。两组术后均无切口感染或钉棒松动、断裂及脱落情况,A组术后有1例患者邻近椎体骨折。结论经伤椎短节段后路内固定治疗胸腰椎骨折的手术时间、切口长度较以皮跨伤椎长,失血量多,但中远期的临床疗效显著,可为患者胸腰椎提供持续稳定的力学性能。

Objective To analyze and compare the clinical efficacy and mechanical properties between percutaneous trans-traumatic and trans-traumatic short-segment posterior fixation for thoracolumbar fractures.Methods Thirty-five patients with thoracolumbar fracture admitted to Xinjiang Uygur Autonomous Region Hospital of Traditional Chinese Medicine from March 2017 to March 2018 were selected.Percutaneous trans-traumatic or trans-traumatic posterior instrumentation was performed according to the patients’wishes,and they were divided into group A(17 cases)and group B(18 cases).After 12 months follow-up,the operative indexes of the two groups were compared:operation time,blood loss,incision length,mechanical properties before and after operation,Cobb angle,height ratio of fracture anterior edge.clinical effect indexes of preoperative and final follow-up were pain visual analogue score(VAS)and Oswestry dysfunction index(ODI),and the safety of surgical treatment was evaluated.Results The operation time,blood loss,and incision length in group B were more than those in group A(P<0.05).The Cobb angle of kyphosis and the height ratio of anterior vertebral edge of fracture in the two groups were significantly improved after operation(P<0.05).There was no significant difference in the above mechanical properties between the two groups before and 1 week after operation(P>0.05).At the last follow-up,the mechanical properties of group B were significantly better than those of group A(P<0.05).Until the last follow-up,the VAS and ODI scores of pain in both groups were significantly decreased(P<0.05),and group B was significantly lower than group A(P<0.05).In addition,the difference of VAS score and ODI score in group A was lower than that in group B(P<0.05).There were no incision infection,loosening,breaking and falling of screw rod in both groups.There was one case of adjacent vertebral fracture in group A after operation.Conclusion Percutaneous transpedicular short-segment posterior fixation for the treatment of thoracolumbar fractures has relatively poor surgical indicators,but the long-term clinical efficacy is significant,which can provide patients with sustained and stable mechanical properties of the thoracolumbar spine.