经皮内固定系统对创伤性胸腰椎骨折疗效、应激反应以及血清NSE、GFAP水平的影响

Effect of percutaneous internal fixation system on traumatic thoracolumbar fractures,stress response,serum NSE and GFAP levels

目的探讨经皮内固定系统对创伤性胸腰椎骨折疗效及应激反应、血清胶质纤维酸性蛋白(glial fibrillary acidic protein,GFAP)、神经元特异性烯醇化酶(neuron specific enolase,NSE)水平的影响。方法纳入2017年2月~2019年2月该院收治的84例创伤性胸腰椎骨折患者,均采用椎弓根内固定系统治疗,按不同术式分组:40例传统入路,44例经皮内固定,分别设为对照组及观察组。比较两组的手术、随访、应激反应相关指标以及血清NSE、GFAP水平。结果与对照组比较,观察组术中出血量、下床时间、住院时间等数据显著更低(P<0.05),两组手术时间无显著差异(P>0.05);与术前比较,两组术后1周、末次随访疼痛VAS评分、Cobb角明显下降,伤椎前缘高度比明显增加,术后1周观察组VAS评分显著低于对照组(P<0.05),但两组间各时期影像指标无统计学意义(P>0.05);两组术后1 d、1周的肾上腺素、去甲肾上腺素显著高于术前,血清NSE、GFAP水平显著低于术前(P<0.05),但观察组术后1 d、1周的各项指标与对照组均有显著差异(P<0.05)。结论经皮内固定术治疗创伤性胸腰椎骨折,能获得与传统手术入路一致的效果,但前者早期疼痛更轻,能减轻术后早期应激反应以及脊髓、神经微损伤。

Objective To explore the effect of percutaneous internal fixation system on the therapeutic effect and stress response of traumatic thoracolumbar fractures,serum glial fibrillary acidic protein(GFAP),neuron specific enolase(NSE)levels.Methods Eighty-four patients with traumatic thoracolumbar fractures in our hospital from February 2017 to February 2019 were selected as the study subjects,and all were treated with pedicle internal fixation system.They were divided into two groups according to different surgical methods.Forty cases were used traditional surgical approach,44 cases were used percutaneous internal fixation system,which were respectively set as the control group and the observation group.The surgical indicators,follow-up indicators,stress response-related indicators,and serum NSE and GFAP levels between the two groups were compared.Results Compared with the control group,the observation group had significantly lower intraoperative blood loss,less time to get out of bed,and shorter hospital stay(P<0.05).The difference in operation time was not significant(P>0.05).Compared with those preoperatively,the visual analogue scale(VAS)and Cobb angle of pain of the two groups decreased significantly on the 7th day after surgery and in the last follow-up,and the ratio of the height of the anterior edge of the injured vertebrae increased significantly.The VAS score of the observation group was lower than that of the control group on the 7th day after surgery(P<0.05).However,there was no statistically significant difference in imaging indicators between groups in each period(P>0.05).The levels of adrenaline and norepinephrine one day and one week after surgery were higher than those before surgery,and serum NSE and GFAP levels of two groups were lower than those before surgery(P<0.05).However,the indicators in the observation group were significantly different from those in the control group one day and one week after operation(P<0.05).Conclusion Percutaneous internal fixation system for the treatment of traumatic thoracolumbar fractures can achieve the same deformity correction and internal fixation effects as the traditional surgical approach,but the former has less early pain and can reduce the early postoperative stress response and spinal cord and nerve micro-injury.