高压氧联合椎弓根钉内固定对改善脊柱骨折形态及功能的应用效果

Application effect of hyperbaric oxygen combined with pedicle screw internal fixation on improving the morphology and function of spinal fractures

目的观察高压氧辅助弓根钉内固定术治疗脊柱骨折的效果,及对患者脊柱形态、功能的影响。方法本研究为前瞻性研究,选择郑州大学附属郑州中心医院2022年1月至2023年6月期间收治的109例脊柱骨折患者为研究对象,以计算机随机分组法将其分为手术组(54例)和联合组(55例),手术组采用弓根钉内固定术治疗,联合组采用高压氧辅助手术治疗,比较2组患者的炎症因子、脊柱形态、脊柱功能改善情况,术后康复情况及并发症发生情况。结果在不同治疗方案下,联合组的C-反应蛋白(CRP)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)分别为(8.6±1.4)mg/L、(5.4±1.4)pg/ml、(6.6±1.2)pg/ml,均低于手术组[(10.4±2.4)mg/L、(6.3±1.8)pg/ml、(7.3±1.8)pg/ml];联合组术后2周、4周的伤椎后凸角分别为(40±5)°、(28±3)°,均低于手术组[(44±5)°、(31±4)°];Cobb角分别(18.6±4.2)°、(10.3±2.4)°,均低于手术组[(22.4±5.3)°、(12.2±3.2)°];联合组术后2周、4周的Oswestry功能障碍指数(ODI)评分分别为(25±5)分、(18±4)分,均低于手术组[(29±5)分、(22±5)分],日本骨科协会治疗分数(JOA)评分分别为(20±4)分、(24±5)分,均高于手术组[(18±3)分、(20±5)分];联合组的住院时间、卧床时间、骨折愈合时间分别为(10.2±2.3)d、(45±10)d、(85±10)d,均低于手术组[(12.4±3.6)d、(50±11)d、(90±11)d];联合组的术后并发症发生率9.1%(5/55)低于手术组22.2%(12/54),差异均具有统计学意义(P<0.05)。结论高压氧辅助弓根钉内固定术治疗脊柱骨折能有效缓解患者炎症反应,对促进脊柱形态、功能恢复,加快术后康复进程并降低并发症发生风险均有积极意义。

Objective To observe the effectiveness of hyperbaric oxygen assisted arch root nail internal fixation in the treatment of spinal fractures and its impact on the morphology and function of the patients′spine.Methods This study is a prospective study,109 patients with spinal fractures admitted between January 2022 and June 2023 was selected as the study subjects.They were randomly divided into a surgical group(54 cases)and a combined group(55 cases)using computer randomization.The surgical group was treated with arch root nail internal fixation,while the combined group was treated with hyperbaric oxygen assisted surgery.The improvement of inflammatory factors,spinal morphology,spinal function,postoperative rehabilitation and incidence of complications between the two groups were compared.Results Under different treatment regimens,the CRP,IL-6,and IL-8 levels in the combined group were(8.6±1.4)mg/L,(5.4±1.4)pg/ml,and(6.6±1.2)pg/ml,which were lower than those in the surgical group[(10.4±2.4)mg/L,(6.3±1.8)pg/ml,and(7.3±1.8)pg/ml].The posterior convex angles of the injured vertebrae in the combined group were(40±5)°and(28±3)°at 2 and 4 weeks after surgery,which were lower than those in the surgical group[(44±5)°and(31±4)°].The Cobb angles were(18.6±4.2)°and(10.3±2.4)°,which were lower than those in the surgical group[(22.4±5.3)°and(12.2±3.2)°].The ODI scores of the combined group at 2 and 4 weeks after surgery were(25±5)and(18±4),which were lower than those in the surgical group[(29±5)and(22±5)],while the JOA scores were(20±4)and(24±5),which were higher than those of the surgical group[(18±3)and(20±5)].The hospitalization time,bed rest time,and fracture healing time of the combined group were(10.2±2.3)days,(45±10)days,and(85±10)days,which were lower than those in the surgical group[(12.4±3.6)days,(50±11)days,and(90±11)days.The incidence of postoperative complications in the combined group was 9.1%(5/55),which were lower than that in the surgical group 22.2%(12/54)(P<0.05).Conclusion The treatment of spinal fractures with high-pressure oxygen assisted arch root nail internal fixation can effectively alleviate the inflammatory response of patients,promote the recovery of spinal morphology and function,accelerate the postoperative rehabilitation process,and reduce the risk of complications.