经伤椎与跨伤椎6钉固定屈曲牵张型胸腰椎骨折

Three-pair pedicle screws with or without placement in the injured vertebrae for flexion-distraction thoracolumbar fractures

[目的]比较经伤椎与跨伤椎6钉固定治疗屈曲牵张型胸腰椎骨折的临床疗效。[方法]回顾性分析2017年1月—2020年12月椎弓钉固定屈曲牵张胸腰椎骨折43例患者的临床资料。依据术前医患沟通结果,20例采用跨伤椎6钉固定,23例采用经伤椎6钉固定,比较两组围手术期、随访和影像学资料。[结果]所有患者顺利完成手术,术中无神经损伤,跨伤椎组切口长度显著大于经伤椎组(P<0.05);两组手术时间、术中失血量、术中透视次数、住院时间的差异均无统计学意义(P>0.05),两组切口均Ⅰ期愈合。随访时间平均(19.6±5.2)个月。两组患者下地行走时间、完全负重活动时间的差异无统计学意义(P>0.05)。随时间推移,两组VAS和ODI评分均显著降低(P<0.05),JOA评分显著增加(P<0.05),ASIA评级显著改善(P<0.05)。相应时间点,两组间上述指标的差异均无统计学意义(P>0.05)。影像方面,与术前相比,术后即刻及末次随访时两组椎体前缘相对高度、腰椎前凸角显著增加(P<0.05),而局部后凸Cobb角显著减小(P<0.05),术前两组上述影像指标的差异均无统计学意义(P>0.05),术后即刻和末次随访时,跨伤椎组上述指标均显著优于经伤椎组(P<0.05)。[结论]两组患者均取得满意的临床疗效,但跨伤椎6钉固定治疗屈曲牵张型胸腰椎骨折在矫正脊柱后凸畸形,维持伤椎高度恢复方面,优于经伤椎6钉固定。

[Objective] To compare the clinical efficacy of 3-pair pedicle screws with or without placement in the injured vertebrae for flexion-distraction thoracolumbar fractures. [Methods] A retrospective study was performed on 43 patients who received pedicle screw fixation of flexion-distraction thoracolumbar fractures in our department from January 2017 to December 2020. According to the preoperative doctor-patient communication, 20 cases underwent 3-pair pedicle screws with non-placement in the injured vertebrae(PSNIV), while the remaining 23 cases received 3-pair pedicle screws with placement in the injured vertebrae(PSIV). The two groups were compared regarding perioperative, follow-up and radiographic documents. [Results] All patients in both groups received successful surgery with no injury to nerves. The PSNIV group had significantly longer incision than the PSIV(P<0.05), despite no significant difference in terms of operative time, intraoperative blood loss, intraoperative fluoroscopy and hospital stay between the two groups(P>0.05). Patients in both groups were followed up for 16~23 months, with an average of(19.6±5.2) months. There was no significant difference in the time to return walking and the time to resume full-weight bearing activity between the two groups(P>0.05). The ASIA grade for neurological function, as well as VAS,ODI and JOA scores improved significantly in both groups over time(P<0.05), whereas which proved not significantly different between the two groups at any matching time points(P>0.05). Regarding to radiographic assessment, the anterior vertebral height and lumbar lordosis of the two groups was significantly increased(P<0.05), while the local kyphotic Cobb Angle decreased significantly immediately postoperatively and at the latest follow-up compared with those preoperatively(P<0.05). There was no significant difference in the above imaging parameters between the two groups before operation(P>0.05). The PSNIV proved significantly superior to the PSIV in term of correction of the anterior vertebral height, lumbar lordosis and local kyphosis Cobb angle immediately after operation and at the latest follow-up(P<0.05).[Conclusions] Three-pair pedicle screws with or without placement in the injured vertebrae do achieve satisfactory clinical outcomes for flexion-distraction thoracolumbar fractures. In contrast, the 3-pair pedicle screws with non-placement in the injured vertebrae is better than the 3-pair pedicle screws with placement in the injured vertebrae in correcting kyphosis and maintaining the anterior vertebral height.