腰椎骨折行后路短节段钉棒内固定术后矫正度丢失的影像学因素分析

Imaging analysis of correction loss after posterior short segment screw rod internal fixation of lumbar fractures

目的探究腰椎骨折行后路短节段钉棒内固定术后的伤椎矫正情况,以及矫正度丢失的影像学预测因素。方法以我科2017年3月~2020年3月收治的61例腰椎(L_(2)-L_(4))骨折患者作为研究对象,均采用后路短节段钉棒内固定手术治疗。对所有患者术前、术后1周和内固定取出后(即骨折愈合且取出内固定之后1周)的影像学参数进行测量并分析其变化情况,包括伤椎楔形角(vertebral wedge angle,VWA)、伤椎前缘相对高度(anterior vertebrae height,AVH)和局部后凸角(local kyphosis angle,LKA)。矫正丢失度以“△”表示,采用Pearson相关性分析验证△VWA、△AVH、△LKA与患者年龄、随访时间、脊柱骨折载荷分享评分(load sharing scores,LSS)、脊柱脊髓损伤分类及严重程度评分(thoracolumbar injury classification and Severity,TLICS)、邻近椎间盘损伤评分(intervertebral disc injuries,IDIs)的相关性,采用多因素Logistic回归分析筛选术后矫正度丢失的风险因素。结果与术前相比,所有患者术后1周和内固定取出后的VWA、AVH、LKA均获得显著的矫正(P<0.05),但内固定取出后的AVH与LKA值均有所丢失(P<0.05),而VWA未见明显丢失现象(P>0.05)。经Pearson相关性分析,△LKA与LSS评分、IDIs评分、TLICS评分呈正相关性(r=0.745、0.518、0.624);△AVH与LSS评分、TLICS评分均呈正相关性(r=0.312、0.341)。多因素Logistic回归分析显示:LSS评分为△AVH(OR=1.872)和△LKA(OR=2.876)的独立预测因素(均为P<0.05)。结论后路短节段内固定治疗腰椎骨折可起到较好的矫正效果,但术后存在一定程度的AVH和LKA矫正丢失,且与LSS评分、IDIs评分、TLICS评分存在相关性;其中,LSS评分可作为术后△LKA和△AVH的独立预测因素。

Objective To investigate the loss of correction after posterior short segment screw rod internal fixation of lumbar fractures and the imaging predictors of the loss of correction.Methods 61 patients with lumbar spine(L_(2)-L_(4))fractures treated in our department from March 2017 to March 2020 were treated with posterior short segment screw rod internal fixation.The imaging parameters of all patients before operation,1 week after operation and after internal fixation removal(i.e.1 week after fracture healing and internal fixation removal)were measured and analyzed,including the vertebral wedge angle(VWA),the relative height of anterior vertebrae height(AVH)and local kyphosis angle(LKA).The degree of correction loss was expressed by"△".Pearson correlation analysis was used to verify the correlation between△VWA,△AVH,△LKA and patients'age,follow-up time,spinal fracture load sharing score(LSS),thoracolumbar injury classification and Severity(TLICS)and adjacent intervertebral disc injury score(IDIS).Multivariate logistic regression analysis was used to screen the risk factors of postoperative correction loss.Results Compared with before operation,VWA,AVH and LKA of all patients were significantly corrected 1 week after operation and after internal fixation removal(P<0.05),but the values of AVH and LKA were lost after internal fixation removal(P<0.05),while VWA was not significantly lost(P>0.05).By Pearson correlation analysis,△LKA was positively correlated with LSS score,IDIS score and TLICS score (r=0.745,0.518,0.624);△AVH was positively correlated with LSS score and TLICS score(r=0.312,0.341).Multivariate logistic regression analysis showed that LSS scores were independent predictors of△AVH(OR=1.872)and△LKA(OR=2.876)(both P<0.05).Conclusion Posterior short segment internal fixation can achieve good correction effect in the treatment of lumbar fractures,but there is a certain degree of loss of AVH and LKA correction after operation,which is correlated with LSS score,IDIS score and TLICS score;LSS score can be used as an independent predictor of postoperative△LKA and△AVH.