摘要
目的探讨单向与万向椎弓根螺钉经肌间隙入路置入伤椎内固定治疗胸腰椎骨折的疗效。方法选取2015年4月至2018年1月我院脊柱外科经肌间隙入路伤椎短节段内固定治疗的42例胸腰椎骨折患者为研究对象,根据使用的椎弓根螺钉分为单向组(n=18)和万向组(n=24),2组患者均行3椎体6钉短节段固定伤椎,其中单向组经伤椎置入单向椎弓根螺钉,万向组经伤椎置入万向椎弓根螺钉,伤椎上下椎体均置入单向椎弓根螺钉。比较2组患者手术时间、术中出血量及在术前、术后1周及术后1年的视觉模拟量表(VAS)评分、功能障碍指数(ODI)、矢状位伤椎Cobb角及伤椎前缘高度。结果术后随访1年。2组患者手术时间、术中出血量及术后不同时期的ODI、VAS评分比较,差异均无统计学意义(P>0.05)。术前2组患者矢状位伤椎Cobb角及伤椎前缘高度比较,差异无统计学意义(P>0.05);术后1周及术后1年,2组患者矢状位伤椎Cobb角及伤椎前缘高度均较术前有所改善,而单向组患者的矢状位伤椎Cobb角均小于万向组,伤椎前缘高度均大于万向组,差异均有统计学意义(P<0.05)。结论经肌间隙入路伤椎置入万向与单向椎弓根螺钉内固定均能有效改善患者临床症状,但置入单向椎弓根螺钉对于伤椎前缘高度及矢状位伤椎Cobb角有更好的复位效果,能达到更好的解剖复位。
Objective To discuss the curative effect of monoaxial and universal pedicle screw fixation for treatment of thoracolumbar fractures through the intermuscular approach.Methods From April 2015 to January 2018,42 patients with thoracolumbar fractures treated with short-segment internal fixation through intermuscular approach in spine surgery department of our hospital were selected as the study subjects.And these patients were divided into the monoaxial group(n=18)and the universal group(n=24)according to the pedicle screw they used.The patients in the two groups were fixed by short segment fixation with 6 screws in 3 vertebras.Patients in the monoaxial group and the universal group were respectively implanted with monoaxial and universal pedicle screw into the injured vertebra,and the upper and lower vertebra of the injured vertebra were placed with monoaxial pedicle screw.The operative time,intraoperative blood loss,visual analogue scale(VAS)score,Oswestry disability index(ODI),sagittal Cobb angle and the height of the anterior edge of the injured vertebra before operation,1 week and 1 year after operation were compared between the two groups.Results Postoperative follow-up was 1 year.There was no significant difference in terms of operation time,intraoperative blood loss,VAS score and ODI between the two groups in the different period after operation(P>0.05).There was no significant difference in the sagittal Cobb angle and the height of the anterior edge of the injured vertebra between the two groups before surgery(P>0.05).At 1 week and 1 year after surgery,the sagittal Cobb angle and the height of the anterior edge of the injured vertebra were improved in both two groups compared with those before surgery,while in the monoaxial group,the sagittal Cobb angle was smaller than that in the universal group,and the height of the anterior edge of the injured vertebra was greater than that in the universal group,with statistically significant differences(P<0.05).Conclusion Both monoaxial and universal pedicle screw can effectively improve the clinical symptoms of the patients,and the insertion of monoaxial pedicle screw has better effect on the height of the anterior edge of the injured vertebra and the sagittal Cobb angle of the injured vertebra,which can achieve better anatomical reduction.
作者
王滕羽
蒲俊刚
刘瑶瑶
刘鹏
朱军
WANG Teng-yu;PU Jun-gang;LIU Yao-yao;LIU Peng;ZHU Jun(Department of Spine Surgery,Daping Hospital,Army Medical University,Chongqing 400042,China)
出处
《局解手术学杂志》
2020年第9期726-729,共4页
Journal of Regional Anatomy and Operative Surgery
基金
国家自然科学基金(81902257)
陆军军医大学临床医学科研人才培养计划(2018XLC2024)。
关键词
椎弓根螺钉
胸腰椎骨折
伤椎前缘高度
COBB角
pedicle screw
thoracolumbar fracture
the height of the anterior edge of the injured vertebra
Cobb angle
