经伤椎5钉置钉联合对侧植骨治疗不稳定性胸腰椎骨折的效果及对生物力学的影响

Curative effect of 5-nail placement via injured vertebrae combined with contralateral bone grafting on unstable thoracolumbar fractures and its influence on biomechanics

目的探讨经伤椎5钉置钉联合对侧植骨治疗不稳定性胸腰椎骨折的效果及对生物力学的影响。方法抽取2020年8月至2021年10月于晋城市人民医院接受手术治疗的不稳定性胸腰椎骨折患者80例,根据手术方案分为对照组与观察组。对照组34例采用跨伤椎置钉内固定术治疗,观察组46例采用经伤椎5钉置钉联合对侧植骨治疗,比较两组围术期指标。术后随访1年,比较两组后凸Cobb角及伤椎椎体恢复情况、Oswestry功能障碍指数(ODI)、生物力学特征和临床疗效。结果观察组手术时间长于对照组(P<0.05),术中出血量大于对照组(P<0.05),术后卧床时间短于对照组(P<0.05)。术后6、12个月,观察组后凸Cobb角均小于对照组(P均<0.05),伤椎椎体前缘、后缘高度比均高于对照组(P均<0.05),ODI均低于对照组(P均<0.05)。与术后6个月比较,两组术后12个月生物力学特征均明显改善(P均<0.05),且术后6个月观察组荷载800 N时刚度及扭转1.5°时刚度、扭矩均大于对照组(P均<0.05),荷载800 N时位移小于对照组(P<0.05)。观察组骨性融合率(97.83%,45/46)高于对照组(82.35%,28/34),内固定失败率(6.52%,3/46)低于对照组(26.47%,9/34),P<0.05。结论经伤椎5钉置钉联合对侧植骨术治疗不稳定性胸腰椎骨折疗效确切,可有效缩小后凸Cobb角,促进伤椎椎体高度恢复,且生物力学特征良好,益于患者远期预后。

Objective To investigate the efficacy of 5-nail placement via injured vertebrae combined with contralateral bone grafting in the treatment of unstable thoracolumbar fractures,and its influence on biomechanics.Methods Eighty patients with unstable thoracolumbar fractures who received surgical treatment in Jincheng People Hospital from August 2020 to October 2021 were selected and divided into control grooup and observation group according to surgical plans.The control group(34 cases)was treated by trans-injured vertebral nailing and internal fixation,while the observation group(46 cases)was treated by 5-nail placement via injured vertebrae combined with contralateral bone grafting.The perioperative indexes of the two groups were compared.Patients were followed up for 1 year after surgery.The recovery of kyphotic Cobb angle and injured vertebrae,Oswestry disability index(ODI),biomechanical characteristics and clinical efficacy were compared between the two groups.Results Compared with the control group,the observation group had longer operation time(P<0.05),more intraoperative blood loss(P<0.05),and shorter postoperative stay-in-bed time(P<0.05).The observation group had smaller kyphotic Cobb angle(P<0.05),higher ratio of the anterior to posterior height of injured vertebrae(all P<0.05),and lower ODI on 6 and 12 months after treatment(all P<0.05),compared with control group.Compared with indexes 6 months after operation,the biomechanical characteristics of the both groups were significantly improved 12 months after operation(all P<0.05).The stiffness under the load of 800 N,the stiffness and torque in the position of torsion at 1.5°of the observation group were higher than those of the control group 6 months after operation(all P<0.05),while the displacement under the load of 800 N was smaller than that of the control group(P<0.05).The bony fusion rate in the observation group(97.83%,45/46)was higher than that in the control group(82.35%,28/34),and the internal fixation failure rate(6.52%,3/46)was lower than that in the control group(26.47%,9/34),P<0.05.Conclusions Five-nail placement via injured vertebrae combined with contralateral bone grafting has a definite curative effect on unstable thoracolumbar fractures.It can effectively reduce the Cobb angle and promote the recovery of the height of the injured vertebrae.It has good biomechanical characteristics,and is beneficial to the long-term prognosis of patients.