经伤椎椎弓根6钉与跨伤椎椎弓根4钉内固定手术对A1型胸腰椎骨折脊柱稳定性的影响

Effects of Pedicle 6-Screw Internal Fixation through the Injured Vertebra and Pedicle 4-Screw Internal Fixation across the Injured Vertebra on Spinal Stability in A1 Type Thoracolumbar Fractures

目的:研究不同内固定手术对A1型胸腰椎骨折脊柱稳定性的影响。方法:回顾性分析2021年1月至2023年1月期间本院收治的146例A1型胸腰椎骨折患者的临床资料,根据内固定手术方式,将接受经伤椎椎弓根6钉内固定手术的82例患者纳入A组,将接受经跨伤椎椎弓根4钉内固定手术的64例患者纳入B组。比较两组围术期指标、矢状面Cobb角、椎体高度压缩率、Oswestry功能障碍指数(ODI)、应激指标、术后并发症。结果:A组术中出血量(248.49±22.36)mL、卧床时间(4.92±1.24)d、住院天数(8.35±1.76)d与B组[(244.03±20.71)mL、(5.03±1.10)d、(8.75±1.43)d]比较差异无统计学意义(P>0.05);A组手术时间(129.80±17.02)min长于B组(122.95±15.63)min,差异有统计学意义(P<0.05);在T2时点,A组矢状面Cobb角、椎体高度压缩率、ODI均低于B组,差异有统计学意义(P<0.05);两组术后24h、术后3d前列腺素E2(PGE2)、去甲肾上腺素(NE)比较差异无统计学意义(P>0.05);两组术后并发症发生率比较差异无统计学意义(χ^(2)=2.598,P=0.107)。结论:经伤椎椎弓根6钉固定术手术时间较长,但能更有效恢复A1型胸腰椎骨折患者的脊柱稳定性,改善功能障碍。

Objective:To study the effects of different internal fixation operations on the spinal stability of A1 thoracolumbar fracture.Methods:A retrospective analysis was conducted on the clinical data of 146 patients with A1 type thoracolumbar fractures treated in our hospital from January 2021 to January 2023.Based on the method of internal fixation surgery,82 patients who underwent six-screw transpedicular fixation were included in Group A,and 64 patients who underwent four-screw transpedicular fixation were included in Group B.Perioperative indicators,sagittal Cobb angle,vertebral height compression rate,Oswestry Disability Index(ODI),stress indicators,and postoperative complications were compared between the two groups.Results:No significant differences were found between Group A and Group B in terms of intraoperative blood loss(248.49±22.36 mL vs.244.03±20.71 mL),bed rest duration(4.92±1.24 days vs.5.03±1.10 days),and hospital stay length(8.35±1.76 days vs.8.75±1.43 days)(P>0.05).The surgery time was significantly longer in Group A(129.80±17.02 minutes)compared to Group B(122.95±15.63 minutes)(P<0.05).At the T2 time point,the sagittal Cobb angle,vertebral height compression rate,and ODI were significantly lower in Group A than in Group B(P<0.05).There were no significant differences in the levels of prostaglandin E2(PGE2)and norepinephrine(NE)between the two groups at 24 hours and 3 days postoperatively(P>0.05).The incidence of postoperative complications did not differ significantly between the two groups(χ^(2)=2.598,P=0.107).Conclusion:Although the six-screw transpedicular fixation surgery has a longer duration,it more effectively restores spinal stability and improves functional outcomes in patients with A1 type thoracolumbar fractures.