切口改良预防腰椎骨折前路手术后侧方成角的临床研究
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摘要
目的:探讨通过切口改良来预防腰椎骨折前路手术后脊柱侧方的成角。方法:2016年1月至2017年6月纳入40例在腰椎骨折前路手术患者进行研究,40例中男28例,女12例,年龄27～68(39.5±14.9)岁。高处坠落28例,重物砸伤9例,车祸伤3例。L_1椎35例,L_2椎4例,L_3椎1例。骨折椎体AO分型:全部为A型爆裂骨折。脊髓损伤Frankel分级:A级5例,B级1例,C级10例,D级15例,E级9例。内固定材料全部为ANTERIOR(美敦力公司)。患者分为两组:切口改良组(切口方向和切口平面)和常规切口组。对两组患者手术前后骨折节段的冠状面Cobb角,椎体螺钉与相应终板的夹角进行分析。结果:切口改良组术前冠状面Cobb角为(1.20±3.26)°,术后为(2.16±3.55)°;常规切口组术前为(1.22±4.42)°,术后为(3.91±3.78)°。两组术前冠状面Cobb角比较差异无统计学意义,术后差异有统计学意义(P=0.017)。切口改良组患者术后没有出现5°以上的侧方成角,而常规切口组出现6例5°～10°的侧方成角,两组患者术后5°以上侧方成角的发生率差异有统计学意义(P=0.010)。近端的2枚椎体螺钉与相应终板的夹角两组比较差异有统计学意义(P<0.05),而远端的2枚椎体螺钉与相应终板的夹角比较差异无统计学意义(P>0.05)。结论:切口方向和平面的改进可以有效地预防腰椎骨折前路手术术后脊柱侧方成角的发生。
Objective:To explore a method of modified incision to prevent the postoperative spinal lateral angulation via anterior approach for lumbar fracture.Methods:A total 40 patients with lumbar fracture from January 2016 to Jun 2017 were internalized in the study.Including 28 males and 12 females,aged from 27 to 68 years with an average of(39.5±14.9)years.Among them,28 cases caused by high fall,9 cases by heavy injury,3 cases by traffic accidents;and 35 fractures were located at L_1,4 at L_2,1 at L_3.All the fractures were type A based on AO classification.According to Frankel classify of spinal cord injury,5 cases were grade A,1 case was B,10 cases were C,15 cases were D,9 cases were E.The patients were divided randomly into modified incision groups and routine incision groups.All patients were treated with decompression,internal fixation and titanium mesh supported bone graft fusion via anterior approach.All the internal fixation materials were ANTERIOR(Medtronic Inc).Incision direction and incision plane were improved in modified incision groups.The coronal Cobb angle and the angle between the vertebral screw and the corresponding endplate were analyzed before and after operation.Results:Pre and post operative coronal Cobb angles were(1.20±3.26)°,(2.16±3.55)°in modified incision groups and(1.22±4.42)°,(3.91±3.78)°in routine incision groups respectively.And there was no statistical difference before operation,and there was statistical difference after operation between two groups(P=0.017).There was no lateral angulation of more than 5 degrees in modified incision group,but there was lateral angulation of 5 to 10 degrees in routine incision group in 6 cases.The incidence of lateral angulation about 5 degrees after operation was significantly different between two groups(P=0.010).There was significant difference in the angle between the proximal two vertebral screws and the corresponding endplate between two groups(P<0.05),but there was no significant difference in the angle between the distal two vertebral screws and the corresponding endplate(P>0.05).Conclusion:The improvement of incision direction and plane can effectively prevent the postoperative spinal lateral angulation via anterior approach for lumbar fracture.
Objective:To explore a method of modified incision to prevent the postoperative spinal lateral angulation via anterior approach for lumbar fracture.Methods:A total 40 patients with lumbar fracture from January 2016 to Jun 2017 were internalized in the study.Including 28 males and 12 females,aged from 27 to 68 years with an average of(39.5±14.9)years.Among them,28 cases caused by high fall,9 cases by heavy injury,3 cases by traffic accidents;and 35 fractures were located at L_1,4 at L_2,1 at L_3.All the fractures were type A based on AO classification.According to Frankel classify of spinal cord injury,5 cases were grade A,1 case was B,10 cases were C,15 cases were D,9 cases were E.The patients were divided randomly into modified incision groups and routine incision groups.All patients were treated with decompression,internal fixation and titanium mesh supported bone graft fusion via anterior approach.All the internal fixation materials were ANTERIOR(Medtronic Inc).Incision direction and incision plane were improved in modified incision groups.The coronal Cobb angle and the angle between the vertebral screw and the corresponding endplate were analyzed before and after operation.Results:Pre and post operative coronal Cobb angles were(1.20±3.26)°,(2.16±3.55)°in modified incision groups and(1.22±4.42)°,(3.91±3.78)°in routine incision groups respectively.And there was no statistical difference before operation,and there was statistical difference after operation between two groups(P=0.017).There was no lateral angulation of more than 5 degrees in modified incision group,but there was lateral angulation of 5 to 10 degrees in routine incision group in 6 cases.The incidence of lateral angulation about 5 degrees after operation was significantly different between two groups(P=0.010).There was significant difference in the angle between the proximal two vertebral screws and the corresponding endplate between two groups(P<0.05),but there was no significant difference in the angle between the distal two vertebral screws and the corresponding endplate(P>0.05).Conclusion:The improvement of incision direction and plane can effectively prevent the postoperative spinal lateral angulation via anterior approach for lumbar fracture.
引文
[1]Magerl F,Aebi M,Gertzbein SD,et al.A comprehensive classification of thoracic and lumbar injuries[J].Eur Spine J,1994,3(4):184-201.
[2]Yan D,Wang Z,Lv Y,et al.Anterior versus posterior surgical treatment of unstable thoracolumbar burst fracture[J].Eur J Orthop Surg Trauma,2012,22(2):103-109.
[3]Pingel A,Castein J,Kandziora F.Anterior monosegmental stabilization and fusion of an incomplete cranial burst fracture in the thoracolumbar spine via a mini open,thoracoscopically assisted transthoracic approach[J].Eur Spine J,2017,23:1-2.
[4]Cui H,Guo J,Yang L,et al.Comparison of therapeutic effects of anterior decompression and posterior decompression on thoracolumbar spine fracture complicated with spinal nerve injury[J].Pak J Med Sci,2015,31(2):346-350.
[5]艾克热木江·木合热木,孙宇庆,武忠炎,等.胸腰段脊柱爆裂骨折植入物前路与后路修复比较:Cobb角丢失、Frankel功能分级改善以及椎体高度丢失的Meta分析[J].中国组织工程研究,2015,(4):635-641.Aikeremujiang·Muheremu,SUN YQ,WU ZY,et al.Comparison of anterior and posterior approaches for thoracolumbar burst fracture:a Meta analysis on Cobb angle loss,Frankel grading improvement and vertebral height loss[J].Zhongguo Zu Zhi Gong Cheng Yan Jiu,2015,(4):635-641.Chinese.
[6]Ghanayem AJ,Zdeblick TA.Anterior instrumentation in the management of thoracolumbar burst fractures[J].Clin Orthop Relat Res,1997,(335):89-100.
[7]Kaneda K,Taneichi H,Abumi K,et al.Anterior decompression and stabilization with the Kaneda device for thoracolumbar burst fractures associated with neurological deficits[J].J Bone Joint Surg Am,1997,79(1):69-83.
[8]马立泰,刘浩,龚全,等.胸腰椎骨折前路手术椎体螺钉置入角度与术后侧方成角的关系分析[J].中国修复重建外科杂志,2009,23(11):1329-1333.MA LT,LIU H,GONG Q,et al.Relevance of vertebral screws angle and postoperative lateral angulation in anterior approach for thoracic and lumbar fractures[J].Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi,2009,23(11):60-65.Chinese.
[9]马立泰,刘浩,龚全,等.胸腰段骨折前路手术切口平面对术后脊柱侧方成角的影响[J].中华创伤杂志,2011,27(10):868-872.MA LT,LIU H,GONG Q,et al.Impact on postoperative lateral angulation in anterior approach for thoracolumbar fractures as different approach level[J].Zhonghua Chuang Shang Za Zhi,2011,27(10):868-872.Chinese.
[10]马立泰,刘浩,李涛,等.经第11和12肋骨两种手术入路对L1爆裂骨折前路手术置钉角度影响的比较研究[J].中国骨伤,2012,25(12):1005-1009.MA LT,LIU H,LI T,et al.Comparison of screw's inserting angle of via 11th rib and via 12th rib approaches in anterior approach for L1burst fractures[J].Zhongguo Gu Shang/China J Orthop Trauma,2012,25(12):1005-1009.Chinese with abstract in English.
[2]Yan D,Wang Z,Lv Y,et al.Anterior versus posterior surgical treatment of unstable thoracolumbar burst fracture[J].Eur J Orthop Surg Trauma,2012,22(2):103-109.
[3]Pingel A,Castein J,Kandziora F.Anterior monosegmental stabilization and fusion of an incomplete cranial burst fracture in the thoracolumbar spine via a mini open,thoracoscopically assisted transthoracic approach[J].Eur Spine J,2017,23:1-2.
[4]Cui H,Guo J,Yang L,et al.Comparison of therapeutic effects of anterior decompression and posterior decompression on thoracolumbar spine fracture complicated with spinal nerve injury[J].Pak J Med Sci,2015,31(2):346-350.
[5]艾克热木江·木合热木,孙宇庆,武忠炎,等.胸腰段脊柱爆裂骨折植入物前路与后路修复比较:Cobb角丢失、Frankel功能分级改善以及椎体高度丢失的Meta分析[J].中国组织工程研究,2015,(4):635-641.Aikeremujiang·Muheremu,SUN YQ,WU ZY,et al.Comparison of anterior and posterior approaches for thoracolumbar burst fracture:a Meta analysis on Cobb angle loss,Frankel grading improvement and vertebral height loss[J].Zhongguo Zu Zhi Gong Cheng Yan Jiu,2015,(4):635-641.Chinese.
[6]Ghanayem AJ,Zdeblick TA.Anterior instrumentation in the management of thoracolumbar burst fractures[J].Clin Orthop Relat Res,1997,(335):89-100.
[7]Kaneda K,Taneichi H,Abumi K,et al.Anterior decompression and stabilization with the Kaneda device for thoracolumbar burst fractures associated with neurological deficits[J].J Bone Joint Surg Am,1997,79(1):69-83.
[8]马立泰,刘浩,龚全,等.胸腰椎骨折前路手术椎体螺钉置入角度与术后侧方成角的关系分析[J].中国修复重建外科杂志,2009,23(11):1329-1333.MA LT,LIU H,GONG Q,et al.Relevance of vertebral screws angle and postoperative lateral angulation in anterior approach for thoracic and lumbar fractures[J].Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi,2009,23(11):60-65.Chinese.
[9]马立泰,刘浩,龚全,等.胸腰段骨折前路手术切口平面对术后脊柱侧方成角的影响[J].中华创伤杂志,2011,27(10):868-872.MA LT,LIU H,GONG Q,et al.Impact on postoperative lateral angulation in anterior approach for thoracolumbar fractures as different approach level[J].Zhonghua Chuang Shang Za Zhi,2011,27(10):868-872.Chinese.
[10]马立泰,刘浩,李涛,等.经第11和12肋骨两种手术入路对L1爆裂骨折前路手术置钉角度影响的比较研究[J].中国骨伤,2012,25(12):1005-1009.MA LT,LIU H,LI T,et al.Comparison of screw's inserting angle of via 11th rib and via 12th rib approaches in anterior approach for L1burst fractures[J].Zhongguo Gu Shang/China J Orthop Trauma,2012,25(12):1005-1009.Chinese with abstract in English.
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