前后联合入路治疗颈胸段脊柱骨折的临床疗效分析
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摘要
目的:研究前后联合入路治疗颈胸段脊柱骨折的临床效果。方法:选取医院收治的78例颈胸段脊柱骨折患者,采用随机数表法将其分为观察组和对照组,每组39例。观察组患者采用前后联合入路方式治疗;对照组采用单纯前路方式治疗。根据Frankel分级标准进行疗效评定,观察和比较两组患者手术时间、出血量、手术并发症和术后随访12个月的日本骨科协会(JOA)评分、脊柱曲度Cobb角、后凸畸形矫正率,以及骨融合时间、住院时间和神经功能恢复状况。结果:观察组入路方式手术治疗后的疗效评定中,优秀率为61.54%,高于对照组的43.59%;差评率为0.00%,低于对照组的5.13%,差异均有统计学意义(x~2=3.194,x~2=3.335;P<0.05)。术后随访12个月,观察组JOA评分(14.60±2.00)分,高于对照组的(11.00±1.48)分,其差异有统计学意义(t=3.105,P<0.05);Cobb角(10.58±6.03)°,低于对照组的(22.57±10.58)°;矫正率(76.21±13.29)%,高于对照组的(41.68±22.46)%,差异均有统计学意义(t=3.469,t=3.247;P<0.05)。观察组手术时间(130.00±23.50)min、住院时间(33.00±4.85)d,较对照组的(70.50±12.00)min、(21.50±2.10)d延长;出血量(978.00±124.00)ml多于对照组的(560.00±59.40)ml,差异均有统计学意义(t=3.197,t=3.016,t=3.054;P<0.05);但骨融合时间(7.95±2.17)个月,与对照组(8.40±2.30)个月比较,差异无统计学意义(t=1.627,P>0.05)。观察组水肿发生率、内固定失败率低于对照组,差异有统计学意义(x~2=3.315,x~2=3.400;P<0.05)。结论:前后联合入路手术方式有助于充分解除颈胸段脊柱骨折压迫、彻底清除碎骨折碎片、促进植骨融合固定、最大限度恢复脊柱生物力学结构及其功能,是一种有效的入路治疗方式,在严格把握适应症前提下,值得优先选取。
Objective: To study clinical effect of anterior-posterior combined approach in treating spinal fractures of cervical and thoracic segments. Methods: 78 patients with spinal fractures of cervical and thoracic segments were selected. According to the random number table method, these patients were randomly divided into observation group(39 cases) and control group(39 cases). Patients of observation group were treated with anterior-posterior combined approach, while patients of control group were treated with single anterior approach. According to the grading standard of Franke1 to implement evaluation of curative effect, the operation time, amount of bleeding, operative complications and preoperative and postoperative follow-up 12 months JOA score, Cobb angle of spine radian, correction rate of kyphosis, sacralization time, length of stay in hospital and recovery of neurological function were observed and compared. Results: The excellent rate of surgical treatment of observation group(61.54%) was significantly higher than that(43.59%) of control group, and the negative comment rate of observation group(0.00%) was significantly lower than that(5.13%) of control group(x~2=3.194, x~2=3.335, P<0.05). In 12 month postoperative follow-up, the JOA score of observation group(14.60±2.00) points was significantly higher than that of control group(11.00±1.48) points, and the Cobb angle of observation group(10.58±6.03)° was significantly lower than that(22.57±10.58)° of control group, and the correction rate of observation group(76.21±13.29)% was significantly higher than that(41.68±22.46)% of the control group(t=3.105, t=3.469, t=3.548, t=3.247, P<0.05). And the operation time and length stay in hospital of observation group(130.00±23.50 min and 33.00±4.85 days) were significantly longer than those(70.50±12.00 min and 21.50±2.10d) of control group, while the amount of bleeding of observation group(978.00±124.00)mL was significantly larger than(560.00±59.40)mL that of control group(t=3.197, t=3.054, t=3.016, P<0.05). However, there was no significant difference in sacralization time of observation group(7.95±2.17)m compared with that(8.40±2.30)m of the control group(t=1.627, P>0.05). Besides, the incidences of edema and the failure rate of internal fixation of observation group(2.56% and 0.00%) were significantly lower than those(5.13% and 2.56%) of control group(x~2=3.315, x~2=3.400, P<0.05). Conclusion: The anterior-posterior combined approach can effectively relieve the compression of cervical and thoracic spinal fractures, and completely remove broken fragments, and promote the fusion and fixation of bone graft, and recover maximally the biomechanics structure and function of the spine. Therefore, it is an effective curative method, and it is worth to be preferentially chosen under the premise that adaptation disease is strictly held.
Objective: To study clinical effect of anterior-posterior combined approach in treating spinal fractures of cervical and thoracic segments. Methods: 78 patients with spinal fractures of cervical and thoracic segments were selected. According to the random number table method, these patients were randomly divided into observation group(39 cases) and control group(39 cases). Patients of observation group were treated with anterior-posterior combined approach, while patients of control group were treated with single anterior approach. According to the grading standard of Franke1 to implement evaluation of curative effect, the operation time, amount of bleeding, operative complications and preoperative and postoperative follow-up 12 months JOA score, Cobb angle of spine radian, correction rate of kyphosis, sacralization time, length of stay in hospital and recovery of neurological function were observed and compared. Results: The excellent rate of surgical treatment of observation group(61.54%) was significantly higher than that(43.59%) of control group, and the negative comment rate of observation group(0.00%) was significantly lower than that(5.13%) of control group(x~2=3.194, x~2=3.335, P<0.05). In 12 month postoperative follow-up, the JOA score of observation group(14.60±2.00) points was significantly higher than that of control group(11.00±1.48) points, and the Cobb angle of observation group(10.58±6.03)° was significantly lower than that(22.57±10.58)° of control group, and the correction rate of observation group(76.21±13.29)% was significantly higher than that(41.68±22.46)% of the control group(t=3.105, t=3.469, t=3.548, t=3.247, P<0.05). And the operation time and length stay in hospital of observation group(130.00±23.50 min and 33.00±4.85 days) were significantly longer than those(70.50±12.00 min and 21.50±2.10d) of control group, while the amount of bleeding of observation group(978.00±124.00)mL was significantly larger than(560.00±59.40)mL that of control group(t=3.197, t=3.054, t=3.016, P<0.05). However, there was no significant difference in sacralization time of observation group(7.95±2.17)m compared with that(8.40±2.30)m of the control group(t=1.627, P>0.05). Besides, the incidences of edema and the failure rate of internal fixation of observation group(2.56% and 0.00%) were significantly lower than those(5.13% and 2.56%) of control group(x~2=3.315, x~2=3.400, P<0.05). Conclusion: The anterior-posterior combined approach can effectively relieve the compression of cervical and thoracic spinal fractures, and completely remove broken fragments, and promote the fusion and fixation of bone graft, and recover maximally the biomechanics structure and function of the spine. Therefore, it is an effective curative method, and it is worth to be preferentially chosen under the premise that adaptation disease is strictly held.
引文
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[12]管韵致,孙驰,马晓生,等.累及颈胸交界段的多节段颈椎前路融合术后疗效探讨[J].骨科临床与研究杂志,2017,2(2):74-79.
[13]Makary MS,Zucker IL,Sturgeon JM.Venous extravasation and polymethylmethacrylate pulmonary embolism following fluoroscopyguided percutaneous vertebroplasty[J].Acta Radiol Open,2015,4(8):20-58.
[14]Schroeder GD,Kepler CK,Kurd MF,et al.Is It necessary to extend a multilevel posterior cervical decompression and fusion to the upper thoracic spine?[J].Spine,2016,41(23):1845-1849.
[15]王彪,郝定均,郭华,等.颈胸段脊柱结核的手术治疗策略[J].中国脊柱脊髓杂志,2017,27(2):97-103.
[16]Cheng I,Sundberg EB,Iezza A,et al.Biomechanical determination of distal level for fusions across the cervicothoracic junction[J].Global Spine J,2015,5(4):282-286.
[17]李昊宇,元虎.一期前后路联合手术治疗颈胸段脊柱病变的临床疗效分析[J].吉林医学,2017,38(10):1873-1875.
[18]Andras L,Tobin R,Skaggs DL.Congenital cervicothoracic scoliosis treated with hemiepiphysiodesis and placement of distraction-based instrumentation a case report[J].J Bone Joint Surgery Case Connector,2013,3(2):51-56.
[2]Zhang Z,Liu C,Mu Z,et al.Anterior facetectomy for reduction of cervical facet dislocatin[J].Spine,2016,41(7):403-409.
[3]闫廷飞,孙璟川,杨勇,等.Zero-P椎间融合器在颈胸交界处椎间盘突出症治疗中的应用效果[J].中国脊柱脊髓杂志,2017,27(10):872-877.
[4]Zhang Z,Mu Z,Zheng W.Anterior pedicle screw and plate fixation for cervical facet dislocation:case series and technical note[J].Spine J,2016,16(1):123-129.
[5]张吉红,王晓娟,党红胜,等.短节段椎弓根钉内固定治疗非相邻型多节段脊柱骨折的临床研究[J].西部医学,2017,29(1):106-109.
[6]Park MS,Mesfin A,Stoker GE,et al.Sagittal range of motion after extensive cervical fusion[J].Spine J,2014,14(2):338-343.
[7]张伟,赵晗柯,徐诚,等.脊柱骨折行内固定结合椎体成形术治疗的效果与临床优势分析[J].创伤外科杂志,2017,19(7):488-491.
[8]闫亮,贺宝荣,刘团江,等.颈胸段脊柱疾病的手术治疗策略[J].中国骨与关节损伤杂志,2017,32(1):10-13.
[9]郝定均.颈胸段脊柱骨折的特点和外科治疗[C].第三届全国脊位损伤治疗与康复研讨会,北京:中国康复医学会,2012:39-43.
[10]伊广坤.两种不同手术入路治疗颈胸段脊柱骨折疗效及安全性比较[J].系统医学,2017,2(13):94-96.
[11]Zhao L,Hong J,Wandtke ME,et al.An RCTstudy on the feasibility of anterior transpedicular screw fixation in the cervicothoracic junction[J].Eur Spine J,2016,25(6):1716-1723.
[12]管韵致,孙驰,马晓生,等.累及颈胸交界段的多节段颈椎前路融合术后疗效探讨[J].骨科临床与研究杂志,2017,2(2):74-79.
[13]Makary MS,Zucker IL,Sturgeon JM.Venous extravasation and polymethylmethacrylate pulmonary embolism following fluoroscopyguided percutaneous vertebroplasty[J].Acta Radiol Open,2015,4(8):20-58.
[14]Schroeder GD,Kepler CK,Kurd MF,et al.Is It necessary to extend a multilevel posterior cervical decompression and fusion to the upper thoracic spine?[J].Spine,2016,41(23):1845-1849.
[15]王彪,郝定均,郭华,等.颈胸段脊柱结核的手术治疗策略[J].中国脊柱脊髓杂志,2017,27(2):97-103.
[16]Cheng I,Sundberg EB,Iezza A,et al.Biomechanical determination of distal level for fusions across the cervicothoracic junction[J].Global Spine J,2015,5(4):282-286.
[17]李昊宇,元虎.一期前后路联合手术治疗颈胸段脊柱病变的临床疗效分析[J].吉林医学,2017,38(10):1873-1875.
[18]Andras L,Tobin R,Skaggs DL.Congenital cervicothoracic scoliosis treated with hemiepiphysiodesis and placement of distraction-based instrumentation a case report[J].J Bone Joint Surgery Case Connector,2013,3(2):51-56.