HXN经皮椎弓根钉内固定治疗创伤胸腰段脊柱骨折患者的疗效研究

Effect of HXN percutaneous pedicle screw fixation in treatment of traumatic thoracolumbar spine fracture

目的 研究脊柱矫形固定器(HXN型)经皮椎弓根钉内固定治疗创伤胸腰段脊柱骨折患者的疗效。方法 采取前瞻性研究,选择2018年2月至2020年12月治疗的胸腰段脊柱骨折患者120例,其中男性66例,女性54例;年龄25~59岁,平均年龄45.12岁;身体质量指数18~30 kg/m^(2),平均身体质量指数24.42 kg/m^(2);骨折原因,车祸伤45例,摔伤55例,暴力伤20例;骨折位置T1114例,T1239例,L159例,L28例。将患者随机分为对照组(n=62)和观察组(n=58),观察组患者采取HXN经皮椎弓根钉内固定治疗,对照组患者采取开放固定术治疗。分别对两组手术指标、影像学指标、疼痛情况进行比较。结果 观察组术中出血量、住院时间、切口长度显著低于对照组[(199.78±22.56) mL vs (236.18±22.17) mL,(10.83±1.93) d vs (12.73±1.23) d,(101.52±2.82) mm vs (126.32±1.13) mm],差异有显著统计学意义(t=8.914、6.431、63.233,P=0.000、0.000、0.000)。经过治疗后,两组Cobb角显著降低[术前观察组(14.83±1.93)°、对照组(14.73±1.33)°,术后分别为(4.43±0.83)°、(6.33±1.13)°],椎体前缘高度、椎体矢状面指数均显著升高[椎体前缘高度术前观察组(60.74±11.14)%、对照组(61.66±11.47)%,术后分别为(94.44±13.37)%、(84.36±13.33)%;椎体矢状面指数术前观察组(66.48±13.33)%、对照组(64.34±13.13)%,术后分别为(91.78±13.46)%、(86.18±13.17)%],且观察组Cobb角显著低于对照组(t=10.497,P=0.000),而椎体前缘高度、椎体矢状面指数显著高于对照组(t=4.136、2.303,P=0.000、0.000)。两组视觉模拟量表(VAS)评分均显著下降,且观察组VAS评分低于对照组(P<0.05)。结论 HXN经皮椎弓根钉内固定治疗创伤胸腰段脊柱骨折患者效果显著。

Objective To study the efficacy of HXN percutaneous pedicle screw fixation in treatment of traumatic thoracolumbar spine fracture.Methods From February 2018 to December 2020,a total of 120 patients with thoracolumbar spine fractures were enrolled,which included 66 males and 54 female,aged 25-59 years old with mean age of 45.12 years old;body mass index(BMI) was 18-30 kg/m^(2)with mean BMI of 24.42 kg/m^(2).There were 45 cases of traffic accident injury,55of fall injury and 20 of violent injury.The fracture location was T11in 14 cases,T12in 39,L1in 59 and L2in 8.All of them were randomly divided into control group (n=62) and observation group (n=58).The observation group performed HXN percutaneous pedicle screw internal fixation,and control group were treated with open fixation.The operation indexes,imaging indexes and pain were compared between 2 groups.Results The intraoperative blood loss,hospitalization time and incision length in observation group were statistically significantly lower than those in control group[(199.78±22.56) mL vs (236.18±22.17) mL,(10.83±1.93) days vs (12.73±1.23) days,(101.52±2.82) mm vs (126.32±1.13) mm](t=8.914,6.431,63.233,P=0.0000.000,0.000).After treatment,the Cobb angle of 2 groups were significantly decreased[before treatment:observation group (14.83±1.93)°,control group (14.73±1.33)°;after treatment:observation group (4.43±0.83)°,(6.33±1.13)°],the anterior height of vertebral body and sagittal index of vertebral body were significantly increased[anterior height of vertebral body before treatment:observation group (60.74±11.14)%,control group (61.66±11.47)%;after treatment:observation group (94.44±13.37)%,control group (84.36±13.33)%;sagittal index of vertebral body before treatment:observation group (66.48±13.33)%,control group (64.34±13.13)%after treatment:observation group (91.78±13.46)%,control group (86.18±13.17)%],and the Cobb angle of observation group was significantly lower than that of control group (t=10.497,P=0.000),while anterior vertebral height and vertebral sagittal index were significantly higher than those of control group (t=4.136,2.303,P=0.000,0.000).The visual analogue scale(VAS)scores of 2 groups were significantly decreased,and VAS score of observation group was significantly lower than that of control group (P<0.05).Conclusion It is demonstrated that HXN percutaneous pedicle screw fixation in treatment of traumatic thoracolumbar spinal fractures showed significant effect.