后路短节段经皮椎弓根螺钉内固定术治疗胸腰椎骨折术中应用横连接的必要性

Necessity of using cross-link during posterior short segment percutaneous pedicle screw fixation for treatment of thoracolumbar fractures

目的探讨后路短节段经皮椎弓根螺钉内固定术治疗胸腰椎骨折术中应用横连接的必要性。方法2019年1月—2021年12月收治胸腰椎骨折患者72例,所有患者均采用后路短节段经皮椎弓根螺钉内固定术治疗,其中37例应用横连接(横连接组),35例未应用横连接(对照组)。记录2组手术时间、术中出血量、住院时间及并发症发生情况。于术后即刻、3个月、12个月在X线片上测量伤椎局部Cobb角、伤椎前缘高度比,采用疼痛视觉模拟量表(VAS)评分评估疼痛程度,采用Oswestry功能障碍指数(ODI)评估脊柱功能。结果所有手术顺利完成,所有患者随访时间>12个月。横连接组手术时间较对照组长,差异有统计学意义(P<0.05)。2组术中出血量及住院天数差异均无统计学意义(P>0.05)。2组各随访时间点伤椎局部Cobb角、伤椎前缘高度比、VAS评分及ODI较术前显著改善,差异均有统计学意义(P<0.05);组间差异均无统计学意义(P>0.05)。结论短节段经皮椎弓根螺钉内固定可提供足够、可靠的稳定性,在该术式中联合应用横连接的临床价值较小。

Objective To investigate the necessity of using cross-link during posterior short segment percutaneous pedicle screw fixation for treatment of thoracolumbar fractures.Methods From January 2019 to December 2021,72 patients with thoracolumbar vertebral fractures were admitted.All the patients were treated with posterior short segment percutaneous pedicle screw fixation,with 37 cases using cross-link(cross-link group)and 35 did not using transverse connection(control group).Operation time,intraoperative blood loss,hospital stay and complications were recorded in 2 groups.The local Cobb angle of injured vertebra and the anterior edge height ratio of the injured vertebra were measured on roentgenograph immediately,3 months and 12 months after surgery.The intensity of pain was assessed by visual analogue scale(VAS)score,and the spinal function was assessed by Oswestry disability index(ODI).Results All the operations were successfully completed,and the follow-up time of all patients was more than 12 months.The operation time of the cross-link group was higher than that of the control group,and the difference was statistically significant(P<0.05).There was no significant difference in intraoperative blood loss and hospital stay between the 2 groups(P>0.05).At each follow-up time point,the local Cobb angle of injured vertebra,the anterior edge height ratio of the injured vertebra,VAS score and ODI in 2 groups were significantly improved compared to those before surgery,and the differences were statistically significant(P<0.05);there was no statistically significant difference between the 2 groups(P>0.05).Conclusion Short segment percutaneous pedicle screw fixation can provide sufficient and reliable spinal stability,and the combined application of cross-link in this operation has little clinical value.