经皮单平面与万向螺钉联合伤椎置钉治疗胸腰椎骨折的疗效研究

Clinical study of percutaneous uniplanar and multiaxial pedicle screw combined with injured vertebrae placement fixation in the treatment of thoracolumbar fractures

目的比较经皮单平面与万向椎弓根螺钉联合伤椎置钉治疗胸腰椎骨折的临床疗效。方法回顾性分析2017年6月~2019年11月收治的65例胸腰椎骨折患者资料,按治疗方法归纳为两组:A组23例,采用经皮单平面螺钉联合伤椎置钉治疗;B组42例,采用经皮万向钉联合伤椎置钉治疗。分别记录两组术前、术后疼痛VAS评分、腰椎Oswestry功能障碍指数(Oswestry disability index,ODI)、手术出血量、手术时间、住院时间、术前术后椎体前缘高度、后凸矫正程度及术后钉尾-钉体角度值(tail-shank angle,TSA)变化。结果65例患者随访12~19个月。两组出血量、手术时间、住院时间均无统计学差异(P>0.05);两组术后VAS评分与ODI指数均较术前明显降低(P<0.05),但两组间差异无统计学意义(P>0.05)。两组术后椎体前缘高度及Cobb角均较术前显著恢复(P<0.05),且A组术后1周、3个月、12个月的椎体前缘高度及Cobb角矫正效果均显著优于B组(P<0.05);与术后1周相比,B组末次随访的椎体前缘高度及Cobb角矫正度均有所丢失(P<0.05)。术后TSA角方面,A组术后1周、3和12个月差异无统计学意义(P>0.05);B组三个时间点有统计学差异(P<0.05)。结论两种方式治疗胸腰椎骨折的效果相当,但是对于椎体高度、Cobb角的恢复、维持方面,单平面螺钉优于万向钉。

Objective To compare the clinical effect of percutaneous uniplanar screw and multiaxial screw combined with injured vertebrae placement fixation in the treatment of thoracolumbar fractures.Methods The clinical data of 65 patients with thoracolumbar fractures who admitted in our hospital from June 2017 to November 2019 were retrospectively analyzed.They were divided into two groups according to treatment methods.Group A(23 patients)was treated with percutaneous uniplanar pedicle screw fixation placement on injured vertebrae.Group B(42 patients)was treated with percutaneous multiaxial pedicle screw fixation placement on injured vertebrae.The visual analogue scale(VAS),Oswestry disability index(ODI),blood loss,operation time,hospital stay,anterior vertebral body height,kyphosis correction and tail-shank angle(TSA)were recorded.Results All 65 patients were followed up for 12 to 19 months.There were no significant differences in blood loss,operation time and hospital stay between the two groups(P>0.05).The VAS score and ODI index of the two groups after operation were significantly lower than before operation(P<0.05),but there were no significant differences between the two groups(P>0.05).The height of the anterior edge of the vertebral body and the Cobb angle of the two groups recovered significantly after operation compared with before operation(P<0.05),and the correction effect of the height of the anterior edge of the vertebral body and the Cobb angle of group A was significantly better than that of group B at 1 week,3 months and 12 months after operation(P<0.05).Compared with 1 week after operation,the height of the anterior edge of the vertebral body and the correction of Cobb angle in the last follow-up in group B were lost(P<0.05).In terms of postoperative TSA angle,there was no significant difference in group A at 1 week,3 months and 12 months after operation(P>0.05).There was statistically significant difference at three time points in group B(P<0.05).Conclusion s These two methods in the treatment of thoracolumbar fractures can achieve satisfied efficacy.However,uniplanar pedicle screw has the advantage of recovering and maintaining the anterior vertebral body height and Cobb angle.