不同内固定术治疗创伤性胸腰椎骨折的效果对比

Comparison of Effect of Different Internal Fixation in the Treatment of Traumatic Thoracolumbar Fracture

目的:比较不同内固定术治疗创伤性胸腰椎骨折的效果。方法:选取2021年1月-2022年1月仁怀市中医院收治的胸腰椎骨折患者100例作为研究对象,采用随机数字表法分为对照组和观察组,各50例。对照组采用经皮入路椎弓根钉棒系统内固定治疗,观察组采用经椎旁肌间隙入路椎弓根钉棒系统内固定治疗。比较两组围术期指标及骨折愈合时间、骨代谢活性指标、围术期并发症、疼痛程度与功能障碍情况。结果:两组手术时间、术中出血量比较,差异无统计学意义(P>0.05);观察组住院时间、骨折愈合时间短于对照组,差异有统计学意义(P<0.001)。术后1个月,两组骨钙素(BGP)、骨保护素(OPG)水平高于术前,Ⅰ型胶原C端肽(CTX-Ⅰ)水平低于术前,差异有统计学意义(P<0.05);术后1个月,观察组BGP和OPG水平高于对照组,CTX-Ⅰ水平低于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率低于对照组,差异有统计学意义(P=0.029)。术后3个月,两组视觉模拟评分、Oswestry功能障碍指数均降低,观察组低于对照组,差异有统计学意义(P<0.001)。结论:两种手术方式均具有良好的预后效果,但经椎旁肌间隙入路的椎弓根钉棒系统内固定方法效果更加显著,在提高患者围术期指标与提高骨代谢活性指标的同时,还可减少并发症,减轻疼痛程度,值得推广。

Objective:To compare the effect of different internal fixation in the treatment of traumatic thoracolumbar fracture.Methods:A total of one hundred patients with thoracolumbar fracture admitted to Renhuai Hospital of Traditional Chinese Medi-cine from January 2021 to January 2022 were selected as the study objects,and were divided into control group and observation group by random number table method,with fifty cases in each group.The control group was treated with percutaneous pedicle screw system,and the observation group was treated with pedicle screw system through paravertebral space.Perioperative indexes,fracture healing time,bone metabolic activity,perioperative complications,pain degree and dysfunction were compared between the two groups.Results:There was no significant difference in operation time and blood loss between the two groups(P>0.05);the length of hospital stay and fracture healing time in observation group were shorter than those in control group,the difference was statistically significant(P<0.001).One month after surgery,the levels of bone glaprotein(BGP)and osteoprotegerin(OPG)of the two groups were higher than before surgery,and the levels of typeⅠcollagen carboxy-terminal peptide(CTX-Ⅰ)were lower than before surgery,with statistical significance(P<0.05);one month after surgery,the levels of BGP and OPG in observation group were higher than those in control group,and the level of CTX-Ⅰwas lower than that in control group,with statistical significance(P<0.05).The complication rate of the observation group was lower than that of the control group,and the difference was statistical-ly significant(P=0.029).At 3 months after surgery,the Visual Analog Score and Oswestry Disability Index of both groups were de-creased,and the observation group was lower than the control group,with statistical significance(P<0.001).Conclusion:The two surgical methods have good prognostic effects,but the pedicle screw system internal fixation method through the paravertebral space approach is more effective.It can not only improve the perioperative indexes of patients and bone metabolic activity indexes,but also reduce complications and relieve pain,which is worthy of promotion.