可调背伸型外固定架治疗稳定性胸腰椎屈曲压缩性骨折的临床研究
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摘要
目的：通过对可调背伸外固定支具及腰部垫枕组治疗前后患者疼痛症状、椎体前缘高度丢失、Cobb’s角变化情况观察,评价治疗稳定型胸腰椎屈曲压缩性骨折时,这两种方法的疗效,从而得出可调背伸外固定支具治疗胸腰段屈曲压缩性骨折的应用价值及推广性。
方法：将30例胸腰椎屈曲压缩骨折患者按照入院先后次序随机编入两组,治疗组15例,垫枕对照组15例,治疗组采用牵引按压法加可调背伸外固定架治疗,对照组采用腰部垫枕治疗。对患者治疗前后临床症状及伤椎椎体前缘高度丢失率和Cobb’s角进行比较。
结果：治疗组及腰部垫枕组治疗前分析p>0.05,无统计学意义,具可比性。经治疗后椎体前缘高度丢失率、Cobb’s角及疼痛临床症状方面均改善,治疗组明显优于腰部垫枕组,具有统计学意义(P<0.05)。
结论：可调背伸型外固定架治疗稳定性胸腰椎屈曲压缩性骨折,为屈曲压缩型稳定性胸腰椎骨折提供一个疗效好、痛苦少、无创伤、恢复快、可早期下床活动避免长期卧床并发症的治疗方法,具有临床推广价值。
Purpose:Through the observation of the treatment of stable flexion compressibility fractures of thoracic and lumbar vertebrae by adjustable back stretch type of external fixation and Waist cushion pillow. Evaluate the clinical efficacy of the two methods, draws a conclusion that adjustable back stretch type of external fixation for thoracolumbar flexion compression fractures of is valuable and it can be popularized widely.
Methods:30 cases of thoracolumbar flexion compression fracture patients into two groups at random,15 cases in treatment group and other 15 cases in control group, the treatment group by pressure traction and adjustable back stretch type of external fixation, the treatment group adopted Waist cushion pillow, comparison with clinical symptoms、injured vertebral height loss of vertebral body edge、Cobb's Angle before and after the treatment.
Results:The analysis of treatment group and the waist cushion pillow groups before treatment, p>0.05,not statistically significant, with comparability.After treatment,injured vertebral height loss of vertebral body edge、Cobb's Angle and clinical pain symptom of treatment group improves better than the treatment group adopted Waist cushion pillow, which has statistically significant (P<0.05)
Conclusion:adjustable back stretch type of external fixation for stable compressibility fractures of thoracic and lumbar vertebrae patients provide a good effect and less painful, no trauma, quick recovery, but early next bed activities avoid long-term laid-in-bed complications treatment method, have clinical popularize value.
方法：将30例胸腰椎屈曲压缩骨折患者按照入院先后次序随机编入两组,治疗组15例,垫枕对照组15例,治疗组采用牵引按压法加可调背伸外固定架治疗,对照组采用腰部垫枕治疗。对患者治疗前后临床症状及伤椎椎体前缘高度丢失率和Cobb’s角进行比较。
结果：治疗组及腰部垫枕组治疗前分析p>0.05,无统计学意义,具可比性。经治疗后椎体前缘高度丢失率、Cobb’s角及疼痛临床症状方面均改善,治疗组明显优于腰部垫枕组,具有统计学意义(P<0.05)。
结论：可调背伸型外固定架治疗稳定性胸腰椎屈曲压缩性骨折,为屈曲压缩型稳定性胸腰椎骨折提供一个疗效好、痛苦少、无创伤、恢复快、可早期下床活动避免长期卧床并发症的治疗方法,具有临床推广价值。
Purpose:Through the observation of the treatment of stable flexion compressibility fractures of thoracic and lumbar vertebrae by adjustable back stretch type of external fixation and Waist cushion pillow. Evaluate the clinical efficacy of the two methods, draws a conclusion that adjustable back stretch type of external fixation for thoracolumbar flexion compression fractures of is valuable and it can be popularized widely.
Methods:30 cases of thoracolumbar flexion compression fracture patients into two groups at random,15 cases in treatment group and other 15 cases in control group, the treatment group by pressure traction and adjustable back stretch type of external fixation, the treatment group adopted Waist cushion pillow, comparison with clinical symptoms、injured vertebral height loss of vertebral body edge、Cobb's Angle before and after the treatment.
Results:The analysis of treatment group and the waist cushion pillow groups before treatment, p>0.05,not statistically significant, with comparability.After treatment,injured vertebral height loss of vertebral body edge、Cobb's Angle and clinical pain symptom of treatment group improves better than the treatment group adopted Waist cushion pillow, which has statistically significant (P<0.05)
Conclusion:adjustable back stretch type of external fixation for stable compressibility fractures of thoracic and lumbar vertebrae patients provide a good effect and less painful, no trauma, quick recovery, but early next bed activities avoid long-term laid-in-bed complications treatment method, have clinical popularize value.
引文
[1]Nicoll EA. Fractures of the dorso lumbar spine. J Bone Joint Surg (Br),1949.31:376.
[2]Whitesides TE.Traumatic kyphosis of the thoracolumbar spine.Clin Orthop.1977,128:78.
[3]Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries[J]. Spine,1983,8 (8):817-831.
[4]McAfee PC, Yuan HA. The value of computed tomography in thoracolumbar fracture.An analysjs of one hundred consecutive cases and a new classification.J bone joint Surg(Am),1983;65:461-473.
[5]Ferguson RL,Allen BI Jr.A mechanism classification of thoracolumbar fracture.Clin orthop,1984;(189):77-88.
[6]雷亮,赵显,冯润,杨利学.俯卧过伸牵引加手法复位治疗胸腰椎压缩骨折.现代中医药,2007,27(2)：30-31.
[7]杨亚东,张海军.手法复位联合垫枕练功治疗胸腰椎压缩性胃折[J].中国医疗前沿,2009,4(12)：37-38.
[8]刘福才,夏宏盛,王琪.悬吊牵引复位治疗单纯胸腰椎楔形压缩骨折疗效观察[J].中国全科医学2009,12(12B)：2232-2233.
[9]陈浩雄,彭力平,徐宁达.垫枕治疗胸腰椎压缩性骨折的应用[J].中医正骨,2008,20(6)：66-67.
[10]万翠萍,吕英.单纯性胸腰椎压缩性骨折垫枕疗法及功能锻炼的护理配合[J].贵阳中医学院学报,2009,31(5)：48-50.
[11]王群,杨玉英,孙莉萍,罗晓红.早期PCA下腰背肌锻炼对胸腰椎压缩性骨折保守治疗及护理[J].护士进修杂志,2009,24(12)：1110-1111.
[12]钟远鸣,许建文,黄民锋等.功能锻炼对无神经损伤胸腰椎骨折伤椎高度恢复的近期效果观察[J].四川中医,2008,26(2)：84-86.
[13]程思琴,林彩霞,廖亚琴等.双柏蜜外敷配合腰背肌功能锻炼治疗胸腰椎压缩性骨折[J].现代医院,2009,9(5)：71-72.
[14]冯立科,代睿欣.腰背肌功能锻炼对胸腰椎压缩骨折患者疼痛改善作用[J].中国医药导报,2008,5(20)：179.
[15]张磊.支具在特发性脊桂侧凸治疗中的价值[J].中国矫形外科杂志,2007,15(1)：50-51.
[16]王玉敏,赵瑞芹.充气支具治疗胸、腰椎骨折231例[J].中国乡村医药杂志,2006,13(8)：25-26.
[17]孙晓亮刘志伟.可调式背伸复位支具治疗无神经症状的胸腰段脊椎骨折46例[J].中华创伤杂志,2000,16(9)：571.
[18]孙长英,牛建民.胸腰骶支架治疗胸腰椎稳定性骨折[J].中国脊柱脊髓杂志,2005,15(7)：448.
[19]曾永华.保守疗法治疗老年人胸腰椎压缩性骨折[J].四川中医,2008,26(5)：88-89.
[20]徐刚.中药治疗老年性胸腰椎压缩性骨折45例[J].实用中医药杂志,2009,25(10)：661.
[21]周崇斌,江松平,郭倩.中药内外合治老年胸腰椎压缩性骨折后便秘60例[J].浙江中医杂志, 2008,43(10)：589.
[22]黄燕萍.松节油点擦神阙穴预防胸腰椎骨折腹胀90例[J].山东中医杂志,2009,28(9)：637-638.
[23]何健.中药加电疗治疗稳定性压缩性胸腰椎骨折200例[J].广西医学,2008,30(12)：1990-1991.
[24]张晋煜,杨祚璋,许建波等.胸腰椎交界节段病理性骨折经皮椎体成形术稳定性的重建[J].昆明医学院学报,2008,29(3)：88-92.
[25]卢斌,蒋国强等.药物合PVP治疗胸腰椎骨质疏松性骨折[J].浙江中西医结合杂志,2007,17(8)：510-511.
[26]吴继功,邹德威等.椎体成形在胸腰椎压缩性骨折后的三维稳定性测试[J].脊柱外科杂志,2009,7(1)：49-52.
[27]苏汝,郑召民,李佛保等.两种填充物在经皮椎体成形术中应用的临床比较[.J].中国骨与关节损伤杂志,2006,21(4)：250-252.
[28]周英杰,赵刚等.复合BMP的磷酸钙骨水泥应用于椎体成形术治疗骨质疏松性胸腰椎压缩骨折15例[J].郑州大学学报(医学版),2009,44(5)：1101-1103.
[29]Garfin SR, YuanHA, ReileyMA. New technologies in spine:kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures[J]. Spine,2001,26 (14):1511-1515.
[30]彭耀庆,何友智.CT引导下经皮穿刺球囊扩张椎体后凸成形术治疗胸腰椎骨折[J].中国现代医学杂志,2009,19(21)：3269-3272.
[31]朴俊红,庞莲萍,刘忠厚,等.中国人口状况及原发性骨质疏松症诊断标准和发生率.中国骨质疏松杂志.2002：8(1)：1-7.
[32]CooperC, Campion G, Melton LJ6. Hip fractures in the elderly:a world 2 wide projection[J]. Osteoporos Int.1992;2(6):285-289.
[33]徐苓,Cummings SR,秦明伟,等.北京老年妇女脊椎骨折的流行病学研究[J].中国骨质疏松杂志,1995,1(1)：81-84.
[34]饶书城主编.脊桂外科手术学.北京：人民卫生出版社,1993,第一版：5.
[35]王亦璁.骨与关节损伤(M).第三版.北京：人民卫生出版社,2005.746.
[36]吉立新.胸腰段压缩骨折腰椎前凸角度及病变椎体倾斜角度的变化特点[J].山东医药,1999,22：9.
[37]顾云五,肖冠军,董福慧等.胸腰段脊桂屈曲型压缩骨折“自身复位”疗法的生物力学探讨.中华骨科杂志,1984,4(1)：14.
[38]黄志,袁国庆,马奔.单纯性胸腰段压缩性骨折采用快速过伸复位法治疗体会[J].中国综合临床,2001,17(5)：391.
[39]范炳华,绍岳军,吕容坤等.垫枕在胸腰椎压缩性骨折中作用原理的光弹研究-Ⅰ[J].中国临床康复,2002,6(2)：202203.
[2]Whitesides TE.Traumatic kyphosis of the thoracolumbar spine.Clin Orthop.1977,128:78.
[3]Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries[J]. Spine,1983,8 (8):817-831.
[4]McAfee PC, Yuan HA. The value of computed tomography in thoracolumbar fracture.An analysjs of one hundred consecutive cases and a new classification.J bone joint Surg(Am),1983;65:461-473.
[5]Ferguson RL,Allen BI Jr.A mechanism classification of thoracolumbar fracture.Clin orthop,1984;(189):77-88.
[6]雷亮,赵显,冯润,杨利学.俯卧过伸牵引加手法复位治疗胸腰椎压缩骨折.现代中医药,2007,27(2)：30-31.
[7]杨亚东,张海军.手法复位联合垫枕练功治疗胸腰椎压缩性胃折[J].中国医疗前沿,2009,4(12)：37-38.
[8]刘福才,夏宏盛,王琪.悬吊牵引复位治疗单纯胸腰椎楔形压缩骨折疗效观察[J].中国全科医学2009,12(12B)：2232-2233.
[9]陈浩雄,彭力平,徐宁达.垫枕治疗胸腰椎压缩性骨折的应用[J].中医正骨,2008,20(6)：66-67.
[10]万翠萍,吕英.单纯性胸腰椎压缩性骨折垫枕疗法及功能锻炼的护理配合[J].贵阳中医学院学报,2009,31(5)：48-50.
[11]王群,杨玉英,孙莉萍,罗晓红.早期PCA下腰背肌锻炼对胸腰椎压缩性骨折保守治疗及护理[J].护士进修杂志,2009,24(12)：1110-1111.
[12]钟远鸣,许建文,黄民锋等.功能锻炼对无神经损伤胸腰椎骨折伤椎高度恢复的近期效果观察[J].四川中医,2008,26(2)：84-86.
[13]程思琴,林彩霞,廖亚琴等.双柏蜜外敷配合腰背肌功能锻炼治疗胸腰椎压缩性骨折[J].现代医院,2009,9(5)：71-72.
[14]冯立科,代睿欣.腰背肌功能锻炼对胸腰椎压缩骨折患者疼痛改善作用[J].中国医药导报,2008,5(20)：179.
[15]张磊.支具在特发性脊桂侧凸治疗中的价值[J].中国矫形外科杂志,2007,15(1)：50-51.
[16]王玉敏,赵瑞芹.充气支具治疗胸、腰椎骨折231例[J].中国乡村医药杂志,2006,13(8)：25-26.
[17]孙晓亮刘志伟.可调式背伸复位支具治疗无神经症状的胸腰段脊椎骨折46例[J].中华创伤杂志,2000,16(9)：571.
[18]孙长英,牛建民.胸腰骶支架治疗胸腰椎稳定性骨折[J].中国脊柱脊髓杂志,2005,15(7)：448.
[19]曾永华.保守疗法治疗老年人胸腰椎压缩性骨折[J].四川中医,2008,26(5)：88-89.
[20]徐刚.中药治疗老年性胸腰椎压缩性骨折45例[J].实用中医药杂志,2009,25(10)：661.
[21]周崇斌,江松平,郭倩.中药内外合治老年胸腰椎压缩性骨折后便秘60例[J].浙江中医杂志, 2008,43(10)：589.
[22]黄燕萍.松节油点擦神阙穴预防胸腰椎骨折腹胀90例[J].山东中医杂志,2009,28(9)：637-638.
[23]何健.中药加电疗治疗稳定性压缩性胸腰椎骨折200例[J].广西医学,2008,30(12)：1990-1991.
[24]张晋煜,杨祚璋,许建波等.胸腰椎交界节段病理性骨折经皮椎体成形术稳定性的重建[J].昆明医学院学报,2008,29(3)：88-92.
[25]卢斌,蒋国强等.药物合PVP治疗胸腰椎骨质疏松性骨折[J].浙江中西医结合杂志,2007,17(8)：510-511.
[26]吴继功,邹德威等.椎体成形在胸腰椎压缩性骨折后的三维稳定性测试[J].脊柱外科杂志,2009,7(1)：49-52.
[27]苏汝,郑召民,李佛保等.两种填充物在经皮椎体成形术中应用的临床比较[.J].中国骨与关节损伤杂志,2006,21(4)：250-252.
[28]周英杰,赵刚等.复合BMP的磷酸钙骨水泥应用于椎体成形术治疗骨质疏松性胸腰椎压缩骨折15例[J].郑州大学学报(医学版),2009,44(5)：1101-1103.
[29]Garfin SR, YuanHA, ReileyMA. New technologies in spine:kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures[J]. Spine,2001,26 (14):1511-1515.
[30]彭耀庆,何友智.CT引导下经皮穿刺球囊扩张椎体后凸成形术治疗胸腰椎骨折[J].中国现代医学杂志,2009,19(21)：3269-3272.
[31]朴俊红,庞莲萍,刘忠厚,等.中国人口状况及原发性骨质疏松症诊断标准和发生率.中国骨质疏松杂志.2002：8(1)：1-7.
[32]CooperC, Campion G, Melton LJ6. Hip fractures in the elderly:a world 2 wide projection[J]. Osteoporos Int.1992;2(6):285-289.
[33]徐苓,Cummings SR,秦明伟,等.北京老年妇女脊椎骨折的流行病学研究[J].中国骨质疏松杂志,1995,1(1)：81-84.
[34]饶书城主编.脊桂外科手术学.北京：人民卫生出版社,1993,第一版：5.
[35]王亦璁.骨与关节损伤(M).第三版.北京：人民卫生出版社,2005.746.
[36]吉立新.胸腰段压缩骨折腰椎前凸角度及病变椎体倾斜角度的变化特点[J].山东医药,1999,22：9.
[37]顾云五,肖冠军,董福慧等.胸腰段脊桂屈曲型压缩骨折“自身复位”疗法的生物力学探讨.中华骨科杂志,1984,4(1)：14.
[38]黄志,袁国庆,马奔.单纯性胸腰段压缩性骨折采用快速过伸复位法治疗体会[J].中国综合临床,2001,17(5)：391.
[39]范炳华,绍岳军,吕容坤等.垫枕在胸腰椎压缩性骨折中作用原理的光弹研究-Ⅰ[J].中国临床康复,2002,6(2)：202203.