短节段椎弓根钉内固定联合高压氧治疗急性脊柱损伤对脊柱形态和功能的影响

Effects of short-segment pedicle screw internal fixation surgery combined with hyperbaric oxygen treatment for acute spinal injury on the morphology and function of the spine

目的:探讨短节段椎弓根钉内固定联合高压氧治疗急性脊柱骨折的效果及对脊髓功能恢复的影响。方法:将2017年2月至2020年3月收治的96例急性脊柱骨折患者分为联合组与对照组,每组48例。两组患者均采用短节段椎弓根钉内固定治疗,其中联合组术后给予高压氧治疗。记录两组患者手术时间、手术出血量、切口长度等一般手术情况,观察手术前后脊柱形态功能,美国脊柱损伤协会(Ameraican Spinal Injury Assiciation,ASIA)神经功能分级,血清炎症因子,日常生活活动能力的差异。结果:两组患者的手术时间、手术出血量、切口长度比较差异无统计学意义(P>0.05)。术前及术后1周、6个月患者的伤椎前缘高度比和Cobb角组间比较差异无统计学意义(P>0.05);两组术后1、6个月的伤椎前缘高度比较术前明显改善(P<0.05),Cobb角较术前明显减小(P<0.05)。术后1 d两组患者的血清白细胞介素-6(interleukin-6,IL-6),白细胞介素-8(interleukin-8,IL-8)和肿瘤坏死因子(tumor necrosis factor-α,TNF-α)水平比较差异无统计学意义(P>0.05);术后1周联合组的血清IL-6、IL-8、TNF-α水平均低于对照组(P<0.05)。术后6个月联合组的ASIA神经功能分级C级2例、D级23例、E级22例,对照组C级7例、D级26例、E级13例,两组比较差异有统计学意义(P<0.05)。术后1、3个月联合组日常生活活动能力的Barthel评分均高于对照组(P<0.05);术后6个月两组患者的Barthel评分比较差异无统计学意义(P>0.05)。结论短节段椎弓根钉内固定联合高压氧治疗急性脊柱骨折有利于患者术后脊髓神经功能恢复,对于早期改善患者日常生活活动能力有一定的作用。

Objective:To explore effect of short-segment pedicle screw internal fixation combined with hyperbaric oxygen in treating acute spinal fractures and its influence on recovery of spinal nerve function.Methods:A total of 96 patients with acute spinal fracture admitted from February 2017 to March 2020 were divided into combined group and control group,with 48 cases in each group.Both groups were treated with short-segment pedicle screw internal fixation.The combined group was given hyperbaric oxygen after surgery.The operation time,surgical blood loss,incision length and other general operation conditions between two groups were recorded.The differences in spinal morphology and function,Ameraican Spinal Injury Assiciation(ASIA)neurological function grade,serum inflammatory factors and ability of daily living activities were observed before and after surgery.Results:There was no significant difference in operation time,surgical blood loss,and incision length between combined group and control group(P>0.05).There were no significant differences in anterior height ratio and Cobb angle between two groups before surgery,1 week and 6 months after surgery(P>0.05).The height ratio of anterior margin of the injured spine was significantly improved in both groups at 1 week and 6 months after surgery compared with preoperative period(P<0.05),and Cobb angle was significantly reduced in both groups compared with preoperative period(P<0.05).There was no statistically significant difference in serum interleukin-6(IL-6),interleukin-8(IL-8),and tumor necrosis factor-α(TNF-α)levels between two groups at 1 d after surgery(P>0.05);the serum IL-6,IL-8,and TNF-αlevels of combined group were lower than those of control group at 1 week after surgery(P<0.05).At 6 months after surgery,ASIA neurological function grade of combined group was C grade in 2 cases,D grade in 23 cases,E grade in 22 cases.In control group,7 cases was grade C,26 cases was grade D,13 cases was grade E,and the difference between two groups was statistically significant(P<0.05).The Barthel score of combined group was higher than that of control group at 1 month and 3 months after surgery,and the difference was statistically significant(P<0.05);at 6 months after surgery,there was no significant difference in Barthel score between two groups(P>0.05).Conclusion:Short-segment pedicle screw internal fixation combined with hyperbaric oxygen for the treatment of acute spinal fractures is beneficial to the recovery of spinal nerve function after surgery,and has a certain effect on the early improvement of the patients’activities of daily living.