过伸牵引弹性按压联合经皮椎弓根钉内固定治疗胸腰椎骨折的生物力学差异
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摘要
背景:治疗胸腰椎骨折的传统经皮椎弓根钉棒内固定在患者术后病椎的高度恢复等方面均存在许多不足,过伸牵引弹性按压联合经皮椎弓根钉内固定术在治疗胸腰椎骨折上提供了新的思路和方法。目的:观察和比较传统经皮椎弓根钉棒内固定术和过伸牵引弹性按压联合经皮椎弓根钉内固定术在治疗胸腰椎骨折上的生物力学差异。方法:回顾性病例分析40例单个椎体的单纯压缩性骨折患者,分别行传统经皮椎弓根螺钉固定术(对照组)和过伸牵引弹性按压联合经皮椎弓根钉内固定术治疗(治疗组)的病历资料,所有患者均无神经症状和体征。比较2组手术围手术期手术时间、术中放射量、术中失血量、住院时间、并发症;内固定前后各时间段伤椎矢状位Cobb’s角、椎体前缘高度百分比。以及使用目测来比评分法评价疼痛情况,Oswestry功能障碍指数量表评价患者症状改善情况。结果与结论:所有患者均获得随访,随访时间为12个月。(1)治疗组围手术期手术时间、术中放射量、术中失血量、住院时间、并发症和对照组比较差异无显著性意义(P>0.05);(2)两组内固定后伤椎矢状位Cobb’s角、椎体前缘高度百分比、目测类比评分及ODI评分显著优于内固定前(P<0.05);(3)治疗组内固定后24 h及6,12个月伤椎矢状位Cobb’s角、椎体前缘高度百分比均显著优于对照组(P<0.05);(4)治疗组术后12个月目测类比评分及Oswestry功能障碍指数评分显著优于对照组(P<0.05);(5)结果说明,过伸牵引弹性按压联合经皮椎弓根钉内固定在恢复椎体高度及疗效上比传统经皮椎弓根钉棒内固定更有优势。
BACKGROUND: The traditional percutaneous pedicle screw fixation for thoracolumbar fractures has a lot of shortcomings, such as restoring the vertebral height. The combination of hyperextension traction-elastic compression and internal percutaneous pedicle screw fixation provides a new treatment strategy. OBJECTIVE: To observe and compare the biomechanical properties of the traditional percutaneous transpedicular screw fixation and hyperextension traction-elastic compression combined with percutaneous pedicle screw fixation in the treatment of thoracolumbar fractures. METHODS: Clinical data of 40 patients with simple vertebral compression fractures undergoing traditional percutaneous pedicle screw fixation(control group) or hyperextension traction-elastic compression combined with percutaneous pedicle screw fixation(treatment group) were analyzed retrospectively, and none had neurologic signs or symptoms. The operation time, intraoperative radiant volume, intraoperative blood loss, hospitalization time or complications were compared between two groups. The sagittal Cobb angle and percentage of anterior height in vertebral body were measured at baseline and different time points after internal fixation. The pain and symptom improvement were evaluated by Visual Analogue Scale and Oswestry Disability Index. RESULTS AND CONCLUSION: All patients were followed up for 12 months.(1) There were no significant differences in the operation time, intraoperative radiation volume, intraoperative blood loss, hospitalization time and complications between two groups(P > 0.05).(2) The sagittal Cobb angle, percentage of anterior height in vertebral body, Visual Analogue Scale and Oswestry Disability Index scores after internal fixation were significantly superior to those before internal fixation in both two groups(P < 0.05).(3) The sagittal Cobb angle and percentage of anterior height in vertebral body in the treatment group were significantly superior to those in the control group at 24 hours, 6 and 12 months postoperatively(P < 0.05).(4) The Visual Analogue Scale and Oswestry Disability Index scores in the treatment group were significantly superior to those in the control group at 12 months postoperatively(P < 0.05).(5) These results indicate that hyperextension traction-elastic compression combined with percutaneous pedicle screw fixation exerts remarkable effect on restoring the vertebral height and effectiveness compared with the traditional percutaneous pedicle screw fixation.
BACKGROUND: The traditional percutaneous pedicle screw fixation for thoracolumbar fractures has a lot of shortcomings, such as restoring the vertebral height. The combination of hyperextension traction-elastic compression and internal percutaneous pedicle screw fixation provides a new treatment strategy. OBJECTIVE: To observe and compare the biomechanical properties of the traditional percutaneous transpedicular screw fixation and hyperextension traction-elastic compression combined with percutaneous pedicle screw fixation in the treatment of thoracolumbar fractures. METHODS: Clinical data of 40 patients with simple vertebral compression fractures undergoing traditional percutaneous pedicle screw fixation(control group) or hyperextension traction-elastic compression combined with percutaneous pedicle screw fixation(treatment group) were analyzed retrospectively, and none had neurologic signs or symptoms. The operation time, intraoperative radiant volume, intraoperative blood loss, hospitalization time or complications were compared between two groups. The sagittal Cobb angle and percentage of anterior height in vertebral body were measured at baseline and different time points after internal fixation. The pain and symptom improvement were evaluated by Visual Analogue Scale and Oswestry Disability Index. RESULTS AND CONCLUSION: All patients were followed up for 12 months.(1) There were no significant differences in the operation time, intraoperative radiation volume, intraoperative blood loss, hospitalization time and complications between two groups(P > 0.05).(2) The sagittal Cobb angle, percentage of anterior height in vertebral body, Visual Analogue Scale and Oswestry Disability Index scores after internal fixation were significantly superior to those before internal fixation in both two groups(P < 0.05).(3) The sagittal Cobb angle and percentage of anterior height in vertebral body in the treatment group were significantly superior to those in the control group at 24 hours, 6 and 12 months postoperatively(P < 0.05).(4) The Visual Analogue Scale and Oswestry Disability Index scores in the treatment group were significantly superior to those in the control group at 12 months postoperatively(P < 0.05).(5) These results indicate that hyperextension traction-elastic compression combined with percutaneous pedicle screw fixation exerts remarkable effect on restoring the vertebral height and effectiveness compared with the traditional percutaneous pedicle screw fixation.
引文
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[3]李智,朱庭标,张勇,等.经皮椎弓根钉技术治疗胸腰椎骨折[J].中国骨与关节损伤杂志,2013,28(9):851-2.
[4]刘洪,王文军.经皮椎弓根钉治疗胸腰椎骨折的临床进展[J].中国矫形外科杂志,2006,14(12):929-31.
[5]熊永发,宁旭,闫飞,等.经皮椎弓根钉内固定与开放手术内固定治疗老年胸腰椎骨折的疗效对比[J].中国老年学杂志,2016,36(4):916-7.
[6]孙涛.胸腰椎压缩性骨折患者采用经皮椎弓根钉内固定治疗的临床体会[J].世界最新医学信息文摘(连续型电子期刊),2015,(58):93.
[7]国家中医药管理局.中医病症诊断疗效标准[J].南京:南京大学出版社,1994,176.
[8]何升华,马笃军,余伟吉,等.过伸牵引弹性按压法联合经皮椎体成形术治疗骨质疏松性胸腰椎压缩骨折的临床研究[J].中医正骨,2014,26(3):25-9.
[9]Wang HW,Li CQ,Zhou Y,et al.Percutaneous pedicle screw fixation through the pedicle of fractured vertebra in the treatment of type A thoracolumbar fractures using Sextant system:an analysis of 38 cases.Chin J Traumatol.2010;13(3):137-45.
[10]李建江,楚戈,杨涛,等.经皮椎间孔镜下TESSYS技术修复腰椎固定融合后邻近节段退行性变[J].中国组织工程研究,2015,19(26):4186-90.
[11]任佳彬,刘鹏飞,孙兆忠,等.椎间孔镜术与传统椎板间开窗术治疗青少年腰椎间盘突出症的比较研究[J].中国矫形外科杂志,2015,(21):1938-42.
[12]梁慕华,蒋劲松,周树权,等.经皮微创椎弓根内固定治疗胸腰椎骨折[J].中国现代医学杂志,2015,20(25):82-86.
[13]林章旺,张毅,孔祥亮,等.经皮椎弓根钉内固定术治疗胸腰椎骨折[J].中国伤残医学,2012,20(10):45-6.
[14]Li K,Li Z,Ren X,et al.Effect of the percutaneous pedicle screw fixation at the fractured vertebra on the treatment of thoracolumbar fractures.Int Orthop.2016;40(6):1103-1110.
[15]Lei L,Guang-wang L,Chao M.[Comparison of the clinical safety and efficacies of percutaneous pedicle screw fixation and open pedicle screw fixation for thoracolumbar fracture:a meta-analysis].Zhongguo Gu Shang.2016;29(3):220-227.
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[17]陈有昌,饶海军.经皮椎弓根钉内固定术治疗胸腰椎骨折临床疗效观察[J].现代诊断与治疗,2016,27(7):1196-1197.
[18]董志辉,董志凯,徐建杰,等.UPASSⅡ经皮椎弓根钉内固定治疗不稳定胸腰椎骨折的疗效分析[J].中国骨与关节损伤杂志,2016,31(7):733-735.
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[20]秦耀维,李树林,徐世稳.3种方法治疗腰椎骨质疏松性椎体压缩骨折的疗效比较分析[J].中国骨与关节损伤杂志,2016,31(7):742-743.
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