后路半椎板不同减压短节段椎弓根螺钉内固定治疗胸腰椎爆裂骨折的临床疗效
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摘要
目的:探究后路半椎板不同减压方式、短节段椎弓根螺钉内固定治疗胸腰椎爆裂骨折的临床疗效。方法:选择北京朝阳急诊抢救中心收治的42例胸腰椎爆裂骨折患者作为研究对象,根据手术方式的不同分为直接减压组(21例)、间接减压组(21例),CT检测手术前后伤椎前缘、后缘高度百分比变化、后弓畸形角(Cobb角)、伤椎横截面积以及上、下位椎管横截面积,计算椎管侵占率。改良Frankel分级法对手术前后患者神经功能恢复情况进行评定,Denis疼痛分级评定、Oswestry功能障碍指数评定法分别对患者患者腰痛情况、腰背功能恢复情况进行评定,对比两组术后并发症发生情况。结果:两组患者术后伤椎前缘高度比例、后缘伤椎高度比例均升高,Cobb角度、椎管侵占率降低,差异有统计学意义(P<0.05)。术后两组患者神经功能均得到改善,Frankel级别相比,差异有统计学意义(P<0.05),组间对比,差异无统计学意义(P>0.05)。两组患者术后腰部疼痛均有所缓解,手术前后Denis疼痛等级对比,差异有统计学意义(P<0.05)。间接减压组Oswestry功能障碍总分高于直接减压组,总发生率低于直接减压组,差异有统计学意义(P<0.05)。结论:后路半椎板减压、短节段椎弓根螺钉内固定是治疗胸腰椎爆裂骨折的有效方法,与直接减压方式相比,间接减压患者术后腰椎功能恢复更好,且并发症发生率低,安全性较高。
Objective: To explore clinical efficacy of posterior decompression with different laminectomy and short segment pedicle screw fixation in treatment of thoracolumbar burst fracture. Methods: 42 cases of patients with thoracolumbar burst fracture treated in Beijing Chaoyang emergency center were selected as the study objects. According to different surgical methods,all the patients were divided into direct decompression group(21 cases) and indirect decompression group(21 cases). The percentage changes of the anterior and posterior edge of the injured vertebra,the deformity angle of posterior arch(Cobb angle),cross-sectional area of injured vertebra and cross-sectional area of the upper and lower vertebral canal were detected by CT,and vertebral canal invasion rate was calculated. Modified Frankel grading method was used to evaluate the recovery of neurological function before and after operation,and low back pain and recovery of back function were evaluated by using Denis grading of pain and Oswestry dysfunction index evaluation method. Postoperative complications of the two groups were compared in the two groups. Results: The proportion of the leading edge of injured vertebra,the height of posterior injury and vertebral height increased,and Cobb angle and the rate of vertebral canal invasion decreased in the two groups,with statistically significant difference(P <0.05). Neurological function of the two groups improved after operation,and there was significant difference in Frankel grade(P <0.05). There was no significant difference between the two groups(P > 0.05). Waist pain relieved in the two groups,and there was statistically significant difference in Denis pain grade before and after operation(P <0.05). Total score of Oswestry dysfunction in indirect decompression group was higher than that in direct decompression group,and the total incidence rate was lower than that in direct decompression group,with statistically significant difference(P < 0. 05). Conclusion: Posterior decompression through laminectomy and short segment pedicle screw fixation is an effective treatment for thoracolumbar burst fractures,and compared with the direct decompression,postoperative lumbar function recovery of patients with indirect decompression is better,and complication rate is low,with higher safety.
Objective: To explore clinical efficacy of posterior decompression with different laminectomy and short segment pedicle screw fixation in treatment of thoracolumbar burst fracture. Methods: 42 cases of patients with thoracolumbar burst fracture treated in Beijing Chaoyang emergency center were selected as the study objects. According to different surgical methods,all the patients were divided into direct decompression group(21 cases) and indirect decompression group(21 cases). The percentage changes of the anterior and posterior edge of the injured vertebra,the deformity angle of posterior arch(Cobb angle),cross-sectional area of injured vertebra and cross-sectional area of the upper and lower vertebral canal were detected by CT,and vertebral canal invasion rate was calculated. Modified Frankel grading method was used to evaluate the recovery of neurological function before and after operation,and low back pain and recovery of back function were evaluated by using Denis grading of pain and Oswestry dysfunction index evaluation method. Postoperative complications of the two groups were compared in the two groups. Results: The proportion of the leading edge of injured vertebra,the height of posterior injury and vertebral height increased,and Cobb angle and the rate of vertebral canal invasion decreased in the two groups,with statistically significant difference(P <0.05). Neurological function of the two groups improved after operation,and there was significant difference in Frankel grade(P <0.05). There was no significant difference between the two groups(P > 0.05). Waist pain relieved in the two groups,and there was statistically significant difference in Denis pain grade before and after operation(P <0.05). Total score of Oswestry dysfunction in indirect decompression group was higher than that in direct decompression group,and the total incidence rate was lower than that in direct decompression group,with statistically significant difference(P < 0. 05). Conclusion: Posterior decompression through laminectomy and short segment pedicle screw fixation is an effective treatment for thoracolumbar burst fractures,and compared with the direct decompression,postoperative lumbar function recovery of patients with indirect decompression is better,and complication rate is low,with higher safety.
引文
[1]刘青峰.经伤椎与跨伤椎后路椎弓根螺钉内固定术治疗胸腰椎爆裂型骨折的临床比较[J].医药论坛杂志,2017(7):170~172.
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[4]邹春锦,季祝永.经伤椎椎弓根植骨结合后路钉棒内固定治疗胸腰椎骨折的临床分析[J].中国伤残医学,2017,25(8):42~43.
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[7]Monticone M,Baiardi P,Vanti C,et al.Responsiveness of the oswestry disability index and the roland morris disability questionnaire in italian subjects with sub-acute and chronic low back pain[J].European Spine Journal,2012,21(1):122~129.
[8]陈少初,张昊,菅新民,等.胸腰椎及腰椎爆裂骨折引发神经功能损伤危险因素分析[J].山西医科大学学报,2015,46(5):479~483.
[9]赵磊.胸腰段脊柱爆裂骨折瞬态损伤机制及节段稳定性研究[J].大家健康旬刊,2015,15(3):708~709.
[10]刘兆勇,杨超.胸腰椎爆裂骨折神经功能损伤的危险因素分析[J].中国医药导报,2013,10(31):50~53.
[11]Parker J W,Lane J R,Karaikovic E E,et al.Successful short-segment instrumentation and fusion for thoracolumbar spine fractures:a consecutive 41/2-year series.[J].Spine,2000,25(9):1157~1163.
[12]张为,李鹏飞,杨大龙,等.颈椎后路减压术后脊髓后移的临床意义[J].中华骨科杂志,2011,31(12):11~14.
[13]焦根龙,李志忠,潘永勤,等.后路开窗减压、伤椎短节段固定治疗胸腰椎爆裂性骨折效果观察[J].山东医药,2013,53(5):15~17.
[14]刘长征,马雪海,郑进,等.后路间接减压植入物内固定与后路椎板切除直视下减压内固定治疗胸腰椎爆裂骨折[J].中国组织工程研究,2011,15(52):9863~9868.
[2]丁少成,曹家俊,魏学忠,等.后路长节段与短节段椎弓根螺钉固定治疗胸腰椎骨折的疗效比较[J].中国修复重建外科杂志,2013,27(6):690~695.
[3]方国芳,周健和,张丁城,等.单纯后路长节段椎弓根钉内固定联合伤椎椎体植骨治疗AO-C型胸腰椎骨折脱位[J].中国骨与关节损伤杂志,2016,31(5):517~518.
[4]邹春锦,季祝永.经伤椎椎弓根植骨结合后路钉棒内固定治疗胸腰椎骨折的临床分析[J].中国伤残医学,2017,25(8):42~43.
[5]Tsou P M,Wang J,Khoo L,et al.A thoracic and lumbar spine injury severity classification based on neurologic function grade,spinal canal deformity,and spinal biomechanical stability[J].Spine Journal,2006,6(6):636~647.
[6]俞红,白跃宏.简式中文版Oswestry功能障碍指数评定下背痛患者的信度及效度分析[J].中华物理医学与康复杂志,2010,32(2):125~127.
[7]Monticone M,Baiardi P,Vanti C,et al.Responsiveness of the oswestry disability index and the roland morris disability questionnaire in italian subjects with sub-acute and chronic low back pain[J].European Spine Journal,2012,21(1):122~129.
[8]陈少初,张昊,菅新民,等.胸腰椎及腰椎爆裂骨折引发神经功能损伤危险因素分析[J].山西医科大学学报,2015,46(5):479~483.
[9]赵磊.胸腰段脊柱爆裂骨折瞬态损伤机制及节段稳定性研究[J].大家健康旬刊,2015,15(3):708~709.
[10]刘兆勇,杨超.胸腰椎爆裂骨折神经功能损伤的危险因素分析[J].中国医药导报,2013,10(31):50~53.
[11]Parker J W,Lane J R,Karaikovic E E,et al.Successful short-segment instrumentation and fusion for thoracolumbar spine fractures:a consecutive 41/2-year series.[J].Spine,2000,25(9):1157~1163.
[12]张为,李鹏飞,杨大龙,等.颈椎后路减压术后脊髓后移的临床意义[J].中华骨科杂志,2011,31(12):11~14.
[13]焦根龙,李志忠,潘永勤,等.后路开窗减压、伤椎短节段固定治疗胸腰椎爆裂性骨折效果观察[J].山东医药,2013,53(5):15~17.
[14]刘长征,马雪海,郑进,等.后路间接减压植入物内固定与后路椎板切除直视下减压内固定治疗胸腰椎爆裂骨折[J].中国组织工程研究,2011,15(52):9863~9868.