摘要
目的采用前瞻性临床随机对照研究,探讨椎弓根-横突通道植钉技术应用于临床的安全性及效果。方法将2015年5月-2017年6月收治且符合选择标准的24例拟行胸椎椎弓根螺钉内固定患者纳入研究,按照随机数字表法分为试验组(采用椎弓根-横突通道植钉技术)和对照组(采用传统植钉技术),每组12例。两组患者年龄、性别、致伤原因、损伤节段、受伤至手术时间等一般资料比较,差异均无统计学意义(P>0.05)。比较两组植钉时间;术后X线片及CT检查植钉情况,计算螺钉植入可接受率及椎弓根壁穿透率。结果试验组植钉时间为(5.08±1.74)min,显著短于对照组的(5.92±1.66)min,差异有统计学意义(t=4.258,P=0.023)。两组患者均获随访,随访时间1~2年,平均1.5年。随访期间均未出现内固定失败。术后1周,试验组螺钉植入Ⅰ级54枚、Ⅱ级3枚、Ⅲ级2枚,螺钉植入可接受率为93.61%;对照组螺钉植入Ⅰ级40枚、Ⅱ级10枚、Ⅲ级8枚、Ⅳ级1枚,螺钉植入可接受率为84.75%。两组螺钉植入可接受率比较差异有统计学意义(χ~2=3.875,P=0.037)。试验组椎弓根壁穿透率为8.47%(5/59),显著低于对照组的32.20%(19/59),差异有统计学意义(χ~2=4.125,P=0.021)。结论与传统植钉技术相比,胸椎术中采用椎弓根-横突通道植钉技术获得的钉道位置更理想,植钉准确性高且操作简便。
Objective To investigate the safety and effectiveness of pedicle screw implantation via vertebral archtransverse pathway in clinical application by a prospective randomized controlled trial. Methods Twenty-four patients who were admitted between May 2015 and June 2017 and met the selection criteria for thoracic pedicle screw fixation were included in the study. According to the random number table method, they were divided into the trial group(screw implantation via vertebral arch-transverse pathway) and the control group(traditional screw implantation technology),with 12 patients in each group. There was no significant difference between the two groups in age, gender, cause of injury,injured segment, and the interval between injury and operation(P>0.05). The time of screw implantation was recorded and compared between the two groups. The acceptable rate of screw implantation and the penetration rate of pedicle wall were calculated after operation. Results The time of screw implantation of trial group was(5.08±1.74) minutes, which was significantly shorter than that of control group [(5.92±1.66) minutes], and the difference was significant(t=4.258,P=0.023). Patients in both groups were followed up 1-2 years, with an average of 1.5 years. During the follow-up, no failure of internal fixation occurred. At 1 week after operation, the screw implantation in trial group was rated as gradeⅠin 54 screws, gradeⅡ in 3 screws, and grade Ⅲ in 2 screws, with the acceptable rate of 93.61%. The screw implantation in control group was rated as gradeⅠin 40 screws, grade Ⅱin 10 screws, grade Ⅲ in 8 screws, and grade Ⅳ in 1 screw, with the acceptable rate of 84.75%. There was significant difference in the acceptable rate of screw implantation between the two groups(χ~2=3.875, P=0.037). The penetration rate of pedicle wall in trial group was 8.47%(5/59), which was significantly lower than that in the control group [32.20%(19/59);χ~2=4.125, P=0.021]. Conclusion Compared with the traditional technique, the pedicle screw implantation via vertebral arch-transverse pathway can obtain a good position of the screw canal with higher accuracy and simpler operation.
作者
钟晖
陈建明
张成程
李占清
陆声
ZHONG Hui;CHEN Jianming;ZHANG Chengcheng;LI Zhanqing;LU Sheng(Department of Spine Surgery,the 926 Hospital of Joint Logistics Support Force of Chinese PLA,Kaiyuan Yunnan,661600,P.R.China;Department of Orthopedics,the First People's Hospital of Yunnan Province,Kunming Yunnan,650032,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2019年第12期1486-1490,共5页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
胸椎
椎弓根-横突通道
植钉
内固定
Thoracic vertebra
vertebral arch-transverse pathway
screw implantation
internal fixation
