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全身骨折中5%~6%是因交通事故、高处跌伤等暴力伤害引起的胸腰椎骨折,其中不乏大量的爆裂性骨折,手术治疗已成为该类病人恢复椎体高度、改善功能障碍以及恢复脊柱正常生理曲度唯一有效的治疗手段。A3型胸腰椎骨折是常见的爆裂性骨折类型,对于无神经损伤者,单纯经皮短节段固定具有良好的临床疗效及微创优势[1]。但A3型骨折中,多数存在终板严重塌陷,部分甚至出现终板粉碎,单纯经皮短节段固定可能存在复位欠佳,而随访期复位丢失可能与难以有效复位终板中央区塌陷有关[2]。为此,我科近年针对伴终板严重塌陷的A3型胸腰椎骨折开展经皮终板复位螺钉技术,旨在提升终板中央区塌陷复位效果。现作报道。
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2组手术时间、术中出血量、住院时间以及术后并发症发生率差异均无统计学意义(P>0.05)(见表 1)。
分组 n 手术
时间/min术中
出血量/mL住院
时间/d并发症 切口感染 慢性腰背痛 压疮 观察组 33 68.33±8.87 56.32±9.78 6.32±2.01 0 1 1 对照组 33 66.01±7.45 54.08±8.92 6.27±1.97 1 2 0 t — 1.15 0.97 0.10 0.00* P — >0.05 >0.05 >0.05 >0.05 *示χ2值 表 1 2组围术期指标及术后并发症发生率比较(x±s)
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与术前相比,2组术后7 d、末次随访后凸Cobb角、VAS评分均降低,伤椎中部高度比、伤椎前缘高度比均升高(P < 0.05~P < 0.01);术前各指标2组差异均无统计学意义(P>0.05),与对照组比较,术后7 d观察组伤椎中部高度比较高(P < 0.01),观察组末次随访后凸Cobb角较低(P < 0.01) (见表 2)。
分组 n 术前 术后7 d 末次随访 后凸Cobb角/(°) 观察组 33 21.54±4.82 5.03±0.98** 5.76±0.78** 对照组 33 21.87±4.65 5.19±0.88** 6.41±0.77** t — 0.28 0.70 3.41 P — >0.05 >0.05 < 0.01 VAS评分/分 观察组 33 7.04±1.32 2.63±0.41** 1.46±0.23**△△ 对照组 33 7.07±1.31 2.70±0.38** 1.52±0.27**△△ t — 0.09 0.72 0.97 P — >0.05 >0.05 >0.05 伤椎中部高度比/% 观察组 33 63.82±6.98 88.03±3.54** 83.14±2.24**△△ 对照组 33 64.07±5.87 75.76±5.48** 69.44±3.47**△△ t — 0.16 10.80# 19.05# P — >0.05 < 0.01 < 0.01 伤椎前缘高度比/% 观察组 33 68.34±6.11 92.76±4.23** 89.19±2.66**△ 对照组 33 67.98±5.98 91.98±5.04** 88.47±3.32**△ t — 0.24 0.68 0.97 P — >0.05 >0.05 >0.05 q检验:与术前比较**P < 0.01,与术后7 d比较△P < 0.05, △△P < 0.01;#示t′值 表 2 2组随访指标比较(x±s)
经皮终板复位螺钉技术在A3型胸腰椎骨折经皮内固定术的应用
Application effects of percutaneous endplate reduction screw technique in percutaneous fixation of type A3 thoracolumbar fractures
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摘要:
目的探讨经皮终板复位螺钉技术在A3型胸腰椎骨折经皮内固定术的运用效果。 方法纳入66例A3型胸腰椎骨折病人,均伴终板严重塌陷,随机均分为2组。对照组采用单纯经皮短节段固定,观察组采用经皮终板复位螺钉技术联合短节段固定,随访2~4年,比较2组围术期手术指标及随访并发症情况,术前、术后7 d、末次随访视觉模拟(VAS)疼痛评分、伤椎中部高度比、伤椎前缘高度比以及后凸Cobb角。 结果2组手术时间、术中出血量、住院时间以及术后并发症发生率差异均无统计学意义(P>0.05);与术前相比,2组术后7 d、末次随访后凸Cobb角、VAS评分均降低,伤椎中部高度比、伤椎前缘高度比均升高(P < 0.05~P < 0.01);术前各指标2组差异均无统计学意义(P>0.05),术后7 d观察组伤椎中部高度高于对照组(P < 0.01),观察组末次随访后凸Cobb角较低(P < 0.01)。 结论经皮终板复位螺钉技术在伴终板严重塌陷的A3型胸腰椎骨折经皮内固定术中能够有效进行终板中央部塌陷复位,减少术后后凸Cobb角及伤椎中部高度丢失。 -
关键词:
- 胸腰椎骨折 /
- 经皮终板复位螺钉技术 /
- 经皮内固定
Abstract:ObjectiveTo explore the application effects of percutaneous endplate reduction screw technique in percutaneous internal fixation of type A3 thoracolumbar fractures. MethodsSixty-six patients with type A3 thoracolumbar fractures complicated with severe endplate collapse were randomly divided into the control group and observation group.The control group was treated with the percutaneous short-segment fixation, and the observation group was treated with percutaneous endplate reduction screw technique combined with short-segment fixation.Two groups were followed up for 2-4 years, the perioperative surgical indicators and following up complications, visual analogue scale(VAS) pain score, ratio of height in the middle and anterior edge of injured vertebra, and Cobb angle of kyphosis before operation, after 7 days of operation and at the last following up were compared between two groups. ResultsThere was no statistical significance in the operation time, intraoperative blood loss, length of hospital stays and incidence rate of postoperative complications between two groups(P>0.05).Compared with before operation, the kyphotic Cobb angle and VAS scores in two groups decreased, and the height ratios of the middle and anterior edge of injured vertebra increased after 7 days of operation and at the last following up(P < 0.05 to P < 0.01).There was no statistical significance in preoperative indexes between two groups(P>0.05).The height of middle of injured vertebra in the observation group after 7 days of operation was higher(P < 0.01), and the kyphotic Cobb Angle was lower in the observation group at the last following up(P < 0.01). ConclusionsThe percutaneous endplate reduction screw technique can effectively reduce the central endplate collapse in the percutaneous fixation of type A3 thoracolumbar fractures complicated with severe endplate collapse, and reduce the loss of postoperative kyphosis Cobb angle and height of the middle injured vertebra. -
表 1 2组围术期指标及术后并发症发生率比较(x±s)
分组 n 手术
时间/min术中
出血量/mL住院
时间/d并发症 切口感染 慢性腰背痛 压疮 观察组 33 68.33±8.87 56.32±9.78 6.32±2.01 0 1 1 对照组 33 66.01±7.45 54.08±8.92 6.27±1.97 1 2 0 t — 1.15 0.97 0.10 0.00* P — >0.05 >0.05 >0.05 >0.05 *示χ2值 表 2 2组随访指标比较(x±s)
分组 n 术前 术后7 d 末次随访 后凸Cobb角/(°) 观察组 33 21.54±4.82 5.03±0.98** 5.76±0.78** 对照组 33 21.87±4.65 5.19±0.88** 6.41±0.77** t — 0.28 0.70 3.41 P — >0.05 >0.05 < 0.01 VAS评分/分 观察组 33 7.04±1.32 2.63±0.41** 1.46±0.23**△△ 对照组 33 7.07±1.31 2.70±0.38** 1.52±0.27**△△ t — 0.09 0.72 0.97 P — >0.05 >0.05 >0.05 伤椎中部高度比/% 观察组 33 63.82±6.98 88.03±3.54** 83.14±2.24**△△ 对照组 33 64.07±5.87 75.76±5.48** 69.44±3.47**△△ t — 0.16 10.80# 19.05# P — >0.05 < 0.01 < 0.01 伤椎前缘高度比/% 观察组 33 68.34±6.11 92.76±4.23** 89.19±2.66**△ 对照组 33 67.98±5.98 91.98±5.04** 88.47±3.32**△ t — 0.24 0.68 0.97 P — >0.05 >0.05 >0.05 q检验:与术前比较**P < 0.01,与术后7 d比较△P < 0.05, △△P < 0.01;#示t′值 -
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