摘要
[目的]比较复位棒辅助复位后伤椎置钉与常规复位前伤椎置钉短节段固定治疗Magerl A3型胸腰椎骨折的临床疗效。[方法]2018年12月一2020年6月收住本院的59例Magerl A3型胸腰椎骨折患者随机分为两组。所有患者均接受短节段椎弓根钉固定,其中,32例采用自制复位棒复位后,再行伤椎置钉(复位置钉组);27例采用常规技术,复位前伤椎置钉(常规组)。比较两组围手术期、随访和影像资料。[结果]两组患者均顺利完成手术,无严重术中并发症。两组手术时间、切口长度、术中失血量、术后引流量、下地行走时间及完全负重时间方面比较差异无统计学意义(P>0.05)。59例患者随访时间12〜21个月,平均(14.42±2.04)个月。随时间推移,两组的VAS及0DI评分均显著减少(P<0.05),相应时间点,两组间VAS及0DI评分的差异均无统计学意义(P>0.05)。影像学方面,与术前相比,术后两组的伤椎前缘相对高度、后凸Cobb角和椎管占位率均显著改善(P<0.05)。相应时间点,两组间伤椎前缘相对高度和Cobb角的差异无统计学意义(P>0.05),但复位置钉组术后3d及末次随访椎管占位率改善显著优于常规组(P<0.05)。[结论]伤椎复位置钉与单纯置钉短节段固定治疗Mag-erl A3型胸腰椎骨折临床疗效无显著差异,但伤椎复位置钉椎管占位的改善优于单纯置钉。
[Objective]To compare the clinical outcomes of pedicle screw placement at the injured vertebra after and before fracture reduction in posterior short-segment fixation for Magerl type A3 thoracolumbar fractures.[Methods]From December 2018 to June 2020,59 patients who were undergoing surgical treatment for Magerl type A3 thoracolumbar fractures were randomly divided into two groups.All the patients received posterior short-segment fixation with the intermediate screws.Of them,32 patients had the screws at injured vertebra placed after fracture reduction by using self-developed reducing rods with the upper and lower pedicle screws(the reduced group),while the remaining 27 patients had the screws placed before fracture reduction as usual(the conventional group).The documents regarding to perioperative period,follow-up and radiographs were compared between the two groups.[Results]All patients in both groups had surgical procedures completed successfully without serious intraoperative complications.There was no statistically significant difference between the two groups in terms of operation time,intraoperative blood loss,incision length,hospital stay,the time to return walking and the time to resume full-weight bearing activity(P>0.05).All the 59 patients were followed up for 12-21 months with an average of(14.42±2.04)months.Both the VAS score and the ODI score decreased significantly in both groups over time(P<0.05),however,no significant difference was noted in the two scores at any corresponding time point between the two groups(P>0.05).Regarding to radiographic assessment,the relative anterior vertebral height,kyphotic Cobb angle and spinal canal occupation ratio significantly improved postoperatively compared with those before operation in both groups(P<0.05).Although there was no statistically significant difference in the relative anterior vertebral height and kyphotic Cobb angle at any matching time point(P>0.05),the reduced group proved significantly superior to the conventional group in term of spinal canal occupation ratio at 3 days after operation and the latest follow-up(P<0.05).[Conclusion]Both short-segment pedicle screw fixation with screws placement at the injured vertebra after or before fracture reduction achieve satisfactory and comparable clinical outcomes for Magerl type A3 thoracolumbar fractures.However,the screws placed after fracture reduction does improve spinal canal occupation better.
作者
庞广兴
刘先银
汪宇
张海滨
周仲华
张小骞
PANG Guang-xing;LIU Xian-yin;WANG Yu;ZHANG Hai-bin;ZHOU Zhong-hua;ZHANG Xiao-qian(Department of Orthopedics,Affiliated Dongguan Hospital,Southern Medical University,Dongguan 523059,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2022年第2期135-139,共5页
Orthopedic Journal of China
基金
广东省医学科学技术研究基金资助项目(编号:A2019267)。
关键词
胸腰椎骨折
复位装置
椎弓根钉固定
伤椎置钉
thoracolumbar fracture
reduction device
pedicle screw fixation
screw placement at fractured vertebra
