经肌间隙入路结合伤椎置钉短节段内固定与传统AF钉棒系统治疗胸腰段骨折的效果比较
|
摘要
背景:手术治疗胸腰段椎体压缩性骨折,可避免患者长期卧床,恢复胸腰段患者矢状面序列,但按照传统的经脊柱正中沿棘突两旁显露剥离肌肉的方法,创伤大出血多,固定后容易出现肌肉失神经支配及慢性背痛。传统方法为跨伤椎4钉固定,长时间随访发现容易出现伤椎高度进一步塌陷及丢失。目的:对比胸腰段骨折患者经手术治疗后康复情况,比较经肌间隙入路结合伤椎置钉短节段内固定与传统AF钉棒系统两种方法治疗胸腰段骨折的临床效果。方法:纳入2009年7月至2014年6月天津市第三中心医院骨科胸腰段骨折患者96例,入院后将患者采用随机数字表法分为2组,经肌间隙入路结合伤椎置钉短节段内固定方法治疗42例,传统AF钉棒系统治疗54例。记录两组手术时间、术中出血量、固定后末次随访引流量、固定后末次随访内固定复位情况,自觉症状改善情况进行评估。结果与结论:(1)随访时间:经肌间隙入路结合伤椎置钉组随访8-12个月,平均13.4个月;AF钉棒系统组随访8-14个月,平均12.1个月。(2)疗效:与AF钉棒系统组比较,经肌间隙入路结合伤椎置钉组出血量、引流量、固定后Cobb角度、固定后末次随访目测类比评分减少(P <0.05),骨折椎体复位率增加(P <0.05)、固定后ASIA分级的自觉症状和神经功能改善情况较好(P<0.05);(3)结果证实:采用经肌间隙入路结合伤椎置钉短节段内固定治疗治疗胸腰段骨折临床效果优于AF钉棒系统。
BACKGROUND: The surgical treatment of thoracolumbar vertebral compression fractures can avoid long-term bedridden patients, and recover thoracolumbar sagittal plane. However, the traditional method of muscle dissection at median spine on both sides along the spinous process revealed big trauma and much wound bleeding. Muscle denervation and chronic back pain easily occur after operation. The traditional method is four screws of cross-wound vertebra, which is easy to collapse and loss with the height of the injured vertebra for a long time. OBJECTIVE: To compare rehabilitation in patients with thoracolumbar fracture after surgical treatment, and to compare the clinical effects of paraspinal approach combined with internal fixation through pedicle of fractured vertebra and traditional AF screw-rod system in the treatment of thoracolumbar fracture. METHODS: A total of 96 cases of thoracolumbar fracture were selected from the Department of Orthopedics, Tianjin Third Central Hospital from July 2009 to June 2014. These patients were randomly divided into two groups. Totally 42 cases were treated by paraspinal approach combined with internal fixation through pedicle of fractured vertebra, while 54 cases received the treatment of traditional AF screw-rod system. Operation time, intraoperative blood loss, postoperative drainage volume, postoperative internal fixation and self-conscious symptom improvement were recorded and evaluated in both groups. RESULTS AND CONCLUSION:(1) Follow-up time: The patients in the paraspinal approach combined with internal fixation through pedicle of fractured vertebra group were followed up for 8-12 months, averagely 13.4 months. Patients in the AF screw-rod system group were followed up for 8-14 months, averagely 12.1 months.(2) Curative effects: Compared with the AF screw-rod system group, blood loss, drainage volume, Cobb angle and Visual Analogue Scale scores were decreased in the paraspinal approach combined with internal fixation through pedicle of fractured vertebra group(P < 0.05), but fractured vertebra reduction rate was increased(P < 0.05); conscious symptoms and neurological function improvement of ASIA grading evaluation were better in the paraspinal approach combined with internal fixation through pedicle of fractured vertebra group than in the AF screw-rod system group(P < 0.05).(3) Paraspinal approach combined with internal fixation through pedicle of fractured vertebra obtained better clinical effect than AF screw-rod system in the treatment of thoracolumbar fractures.
BACKGROUND: The surgical treatment of thoracolumbar vertebral compression fractures can avoid long-term bedridden patients, and recover thoracolumbar sagittal plane. However, the traditional method of muscle dissection at median spine on both sides along the spinous process revealed big trauma and much wound bleeding. Muscle denervation and chronic back pain easily occur after operation. The traditional method is four screws of cross-wound vertebra, which is easy to collapse and loss with the height of the injured vertebra for a long time. OBJECTIVE: To compare rehabilitation in patients with thoracolumbar fracture after surgical treatment, and to compare the clinical effects of paraspinal approach combined with internal fixation through pedicle of fractured vertebra and traditional AF screw-rod system in the treatment of thoracolumbar fracture. METHODS: A total of 96 cases of thoracolumbar fracture were selected from the Department of Orthopedics, Tianjin Third Central Hospital from July 2009 to June 2014. These patients were randomly divided into two groups. Totally 42 cases were treated by paraspinal approach combined with internal fixation through pedicle of fractured vertebra, while 54 cases received the treatment of traditional AF screw-rod system. Operation time, intraoperative blood loss, postoperative drainage volume, postoperative internal fixation and self-conscious symptom improvement were recorded and evaluated in both groups. RESULTS AND CONCLUSION:(1) Follow-up time: The patients in the paraspinal approach combined with internal fixation through pedicle of fractured vertebra group were followed up for 8-12 months, averagely 13.4 months. Patients in the AF screw-rod system group were followed up for 8-14 months, averagely 12.1 months.(2) Curative effects: Compared with the AF screw-rod system group, blood loss, drainage volume, Cobb angle and Visual Analogue Scale scores were decreased in the paraspinal approach combined with internal fixation through pedicle of fractured vertebra group(P < 0.05), but fractured vertebra reduction rate was increased(P < 0.05); conscious symptoms and neurological function improvement of ASIA grading evaluation were better in the paraspinal approach combined with internal fixation through pedicle of fractured vertebra group than in the AF screw-rod system group(P < 0.05).(3) Paraspinal approach combined with internal fixation through pedicle of fractured vertebra obtained better clinical effect than AF screw-rod system in the treatment of thoracolumbar fractures.
引文
[1]魏富鑫,钟锐,崔尚斌,等.经伤椎置钉单椎间复位固定治疗创伤性胸腰椎骨折的远期疗效[J].中华创伤骨科杂志,2014,16(9):760-764.
[2]冯睿,马信龙,马剑雄,等.伤椎置钉短节段内固定和传统短节段内固定治疗胸腰椎骨折疗效的Meta分析[J].中华创伤杂志, 2014,30(6):525-529.
[3]王根林,张福占,谢计乐,等.Wiltse肌间隙入路联合伤椎置钉治疗胸腰段骨折[J].中华创伤骨科杂志,2015,17(12):1047-1052.
[4]Alanay A, Acaroglu E, Yazici M, et al. Short-segment pedicle instrumentation of thoracolumbar burst fractures:does transpedicular intracorporeal grafting prevent early failure? Spine.2001;26(2):213-217.
[5]Alvine GF, Swain JM, Asher MA, et al. Treatment of thoracolumbar burst fractures with variable screw placement or Isola instrumentation and arthrodesis:case series and literature review. J Spinal Disord Tech. 2004;17(4):251-264.
[6]Isaacs RE, Perez CM, Fessler RG, et al. Complications in the treatment of l1 burst fractures. techniques in neurosurgery.Thoracol Trauma. 2003;8(2):130-139.
[7]Finkelstein JA, Wai EK, Jackson SS, et al. Single-level fixation of flexion distraction injuries. J Spinal Disord Tech. 2003;16(2):236-242.
[8]郭朝阳,陈云生,陈荣春.一期后路病灶清除植骨内固定治疗老年性胸腰椎结核[J].实用医学杂志,2013,29(21):3620-3621.
[9]刘涛,申才良,唐开军,等.射频热凝术联合臭氧盘外注射治疗腰椎间盘突出症的疗效分析[J].天津医药,2015,43(12):1443-1446.
[10]王广辉,段维礼,郭坤营.椎管侧前方减压脊柱融合治疗胸腰椎骨折并脊髓损伤[J].实用骨科杂志,2003,9(2):107-108.
[11]唐康,张文志,段丽群,等.微创经皮椎弓根螺钉联合伤椎置钉治疗胸腰段脊椎骨折[J].临床骨科杂志,2014,17(3):253-257.
[12]庞正宝,庞帮镭,汤优民,等.Wiltse入路治疗单节段胸腰椎骨折对多裂肌影响的研究[J].中华骨科杂志,2016,36(2):72-80.
[13]Wiltse LL, Bateman JG, Hutchinson RH, et al. The paraspinal sacrospinalis-splitting approach to the lumbar spine. J Bone Joint Surg Am. 1968;50(5):919-926.
[14]Cappuccio M, Amendola L, Pademi S, et al. Complications in minimally invasive percutaneous fixation of thoracic and lumbar spine fractures. Orthopedics. 2013;36(6):E729-E734.
[15]Tannous O, Shiu B, Koh EY. Minimally invasive spine surgery for thoracolumbar fractures:damage-control spine stabilization.Semin Spine Surg. 2013;25(3):170-175.
[16]Dick JC, Jones MP, Zdeblick TA, et al. A biomechanical comparison evaluating the use of intermediate screws and cross-link-age in lumbar pedicle fixation. J Spine Disord. 1994;7(5):402-407.
[17]袁强,田伟,张贵林,等.骨折椎垂直应力螺钉在胸腰椎骨折中的应用[J].中华骨科杂志,2006,26(4):217-222.
[18][林达生,郭林新,丁真奇,等.椎旁肌间隙入路经伤椎椎弓根植骨内固定治疗胸腰椎骨折[J].中华外科杂志,2011,49(2):125-129.
[19]江正康,林奇生,王一民,等.传统后路与附加伤椎固定治疗胸腰椎骨折比较[J].中华全科医学,2012,10(1):9-10.
[2]冯睿,马信龙,马剑雄,等.伤椎置钉短节段内固定和传统短节段内固定治疗胸腰椎骨折疗效的Meta分析[J].中华创伤杂志, 2014,30(6):525-529.
[3]王根林,张福占,谢计乐,等.Wiltse肌间隙入路联合伤椎置钉治疗胸腰段骨折[J].中华创伤骨科杂志,2015,17(12):1047-1052.
[4]Alanay A, Acaroglu E, Yazici M, et al. Short-segment pedicle instrumentation of thoracolumbar burst fractures:does transpedicular intracorporeal grafting prevent early failure? Spine.2001;26(2):213-217.
[5]Alvine GF, Swain JM, Asher MA, et al. Treatment of thoracolumbar burst fractures with variable screw placement or Isola instrumentation and arthrodesis:case series and literature review. J Spinal Disord Tech. 2004;17(4):251-264.
[6]Isaacs RE, Perez CM, Fessler RG, et al. Complications in the treatment of l1 burst fractures. techniques in neurosurgery.Thoracol Trauma. 2003;8(2):130-139.
[7]Finkelstein JA, Wai EK, Jackson SS, et al. Single-level fixation of flexion distraction injuries. J Spinal Disord Tech. 2003;16(2):236-242.
[8]郭朝阳,陈云生,陈荣春.一期后路病灶清除植骨内固定治疗老年性胸腰椎结核[J].实用医学杂志,2013,29(21):3620-3621.
[9]刘涛,申才良,唐开军,等.射频热凝术联合臭氧盘外注射治疗腰椎间盘突出症的疗效分析[J].天津医药,2015,43(12):1443-1446.
[10]王广辉,段维礼,郭坤营.椎管侧前方减压脊柱融合治疗胸腰椎骨折并脊髓损伤[J].实用骨科杂志,2003,9(2):107-108.
[11]唐康,张文志,段丽群,等.微创经皮椎弓根螺钉联合伤椎置钉治疗胸腰段脊椎骨折[J].临床骨科杂志,2014,17(3):253-257.
[12]庞正宝,庞帮镭,汤优民,等.Wiltse入路治疗单节段胸腰椎骨折对多裂肌影响的研究[J].中华骨科杂志,2016,36(2):72-80.
[13]Wiltse LL, Bateman JG, Hutchinson RH, et al. The paraspinal sacrospinalis-splitting approach to the lumbar spine. J Bone Joint Surg Am. 1968;50(5):919-926.
[14]Cappuccio M, Amendola L, Pademi S, et al. Complications in minimally invasive percutaneous fixation of thoracic and lumbar spine fractures. Orthopedics. 2013;36(6):E729-E734.
[15]Tannous O, Shiu B, Koh EY. Minimally invasive spine surgery for thoracolumbar fractures:damage-control spine stabilization.Semin Spine Surg. 2013;25(3):170-175.
[16]Dick JC, Jones MP, Zdeblick TA, et al. A biomechanical comparison evaluating the use of intermediate screws and cross-link-age in lumbar pedicle fixation. J Spine Disord. 1994;7(5):402-407.
[17]袁强,田伟,张贵林,等.骨折椎垂直应力螺钉在胸腰椎骨折中的应用[J].中华骨科杂志,2006,26(4):217-222.
[18][林达生,郭林新,丁真奇,等.椎旁肌间隙入路经伤椎椎弓根植骨内固定治疗胸腰椎骨折[J].中华外科杂志,2011,49(2):125-129.
[19]江正康,林奇生,王一民,等.传统后路与附加伤椎固定治疗胸腰椎骨折比较[J].中华全科医学,2012,10(1):9-10.