[1]姚明锋,蒋晖,潘育强,等.3种不同手术入路椎弓根钉棒系统内固定治疗胸腰椎骨折的比较研究[J].中医正骨,2021,33(10):16-22.
　YAO Mingfeng,JIANG Hui,PAN Yuqiang,et al.A comparative study of three different surgical approaches in pedicle screw-rod system internal fixation for treatment of thoracolumbar fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(10):16-22.
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3种不同手术入路椎弓根钉棒系统内固定治疗胸腰椎骨折的比较研究()

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期数:
2021年10期
页码:
16-22
栏目:
临床研究
出版日期:
2021-10-20

文章信息/Info

Title:
A comparative study of three different surgical approaches in pedicle screw-rod system internal fixation for treatment of thoracolumbar fractures
作者:
姚明锋; 蒋晖; 潘育强; 戴龚成; 丁辉
(安吉县第三人民医院,浙江 安吉 313301)
Author(s):
YAO Mingfeng; JIANG Hui; PAN Yuqiang; DAI Gongcheng; DING Hui
The Third People’s Hospital of Anji County,Anji 313301,Zhejiang,China
关键词:
脊柱骨折;  胸椎;  腰椎;  骨折固定术; 内;  手术入路
Keywords:
spinal fractures;  thoracic vertebrae;  lumbar vertebrae;  fracture fixation;  internal;  operative approach
摘要:
目的:比较3种不同手术入路椎弓根钉棒系统内固定治疗胸腰椎骨折的临床疗效及安全性。方法:将135例胸腰椎骨折患者随机分为后正中入路组、经皮入路组及椎旁肌间隙入路组,每组45例。3组患者由同一主刀医生进行手术,术中分别采用不同的手术入路植入椎弓根钉棒系统,复位、固定骨折。记录切口长度、手术时间、术中出血量、住院时间及骨折愈合时间。分别于术前和术后3个月,测量伤椎前后缘高度比和伤椎后凸Cobb角,采用Oswestry功能障碍指数(Oswestry disability index,ODI)评价患者术后行动能力与生活能力。观察术后并发症发生情况。分别于术前和术后当天,抽取患者外周静脉血,采用酶联免疫吸附法测定血清肌酸激酶、肌红蛋白和乳酸脱氢酶水平。结果:①一般结果。3组患者切口长度、手术时间、术中出血量、住院时间、骨折愈合时间组间总体比较,差异均有统计学意义[(7.96±0.85)cm,(2.11±0.56)cm,(12.13±3.94)cm,F=206.542,P=0.000;(94.87±9.32)min,(66.72±8.49)min,(53.58±9.97)min,F=180.208,P=0.000;(114.87±14.32)mL,(81.29±11.17)mL,(67.23±9.81)mL,F=189.815,P=0.000;(10.17±2.47)d,(7.38±1.88)d,(6.08±1.69)d,F=47.207,P=0.000;(5.85±1.17)个月,(5.16±1.02)个月,(4.30±0.89)个月,F=25.429,P=0.000]。经皮入路组、椎旁肌间隙入路组患者手术时间、住院时间、骨折愈合时间均较后正中入路组短(P=0.000,P=0.000,P=0.002; P=0.000,P=0.000,P=0.000),术中出血量均较后正中入路组少(P=0.000,P=0.000)。椎旁肌间隙入路组患者手术时间、住院时间、骨折愈合时间均较经皮入路组短(P=0.000,P=0.000,P=0.000),术中出血量较经皮入路组少(P=0.000)。经皮入路组患者切口长度较后正中入路组、椎旁肌间隙入路组短(P=0.000,P=0.000),后正中入路组患者切口长度较椎旁肌间隙入路组短(P=0.000)。②疗效评价结果。术前3组患者伤椎前后缘高度比、伤椎后凸Cobb角、ODI组间总体比较,差异均无统计学意义[(62.15±7.31)%,(61.88±7.45)%,(62.54±6.97)%,F=0.094,P=0.910; 22.15°±1.77°,21.88°±1.55°,21.68°±1.38°,F=0.970,P=0.382;(35.62±2.32)%,(36.37±2.57)%,(35.98±2.11)%,F=1.155,P=0.318]。术后3个月,3组患者伤椎前后缘高度比、伤椎后凸Cobb角、ODI组间总体比较,差异均有统计学意义[(84.87±5.49)%,(89.91±4.63)%,(93.38±4.57)%,F=34.192,P=0.000; 7.55°±1.13°,6.43°±1.19°,5.69°±1.05°,F=28.234,P=0.000;(5.25±1.33)%,(4.53±1.17)%,(3.82±1.12)%,F=15.711,P=0.000]。经皮入路组、椎旁肌间隙入路组患者伤椎前后缘高度比均较后正中入路组高(P=0.000,P=0.000),伤椎后凸Cobb角均较后正中入路组小(P=0.000,P=0.000),ODI均较后正中入路组低(P=0.008,P=0.000); 椎旁肌间隙入路组患者伤椎前后缘高度比较经皮入路组高(P=0.000),伤椎后凸Cobb角较经皮入路组小(P=0.002),ODI较经皮入路组低(P=0.004)。③安全性评价结果。术前,3组患者血清肌酸激酶、肌红蛋白、乳酸脱氢酶水平组间总体比较,差异均无统计学意义[(160.87±21.32)单位·L-1,(162.41±22.57)单位·L-1,(161.53±20.97)单位·L-1,F=0.057,P=0.944;(100.79±18.31)ng·mL-1,(103.19±17.37)ng·mL-1,(101.89±15.97)ng·mL-1,F=0.218,P=0.804;(108.38±18.77)单位·L-1,(111.36±16.35)单位·L-1,(113.81±17.08)单位·L-1,F=1.095,P=0.337]。术后当天,3组患者血清肌酸激酶、肌红蛋白、乳酸脱氢酶水平组间总体比较,差异均有统计学意义[(352.77±57.73)单位·L-1,(254.39±42.53)单位·L-1,(251.08±44.62)单位·L-1,F=63.193,P=0.000;(240.55±25.49)ng·mL-1,(192.53±19.63)ng·mL-1,(189.39±20.17)ng·mL-1,F=76.981,P=0.000;(190.55±21.43)单位·L-1,(163.23±19.19)单位·L-1,(160.33±20.21)单位·L-1,F=31.292,P=0.000]。经皮入路组、椎旁肌间隙入路组3项指标均较后正中入路组低(P=0.000,P=0.000,P=0.000; P=0.000,P=0.000,P=0.000),而这2组间比较,差异均无统计学意义(P=0.728,P=0.456,P=0.487)。后正中入路组术后并发切口感染2例、下肢深静脉血栓2例、内固定断裂1例,经皮入路组术后并发切口感染2例、下肢深静脉血栓1例、内固定断裂1例,椎旁肌间隙入路组术后并发切口感染1例、下肢深静脉血栓2例、内固定断裂1例; 3组患者并发症发生率比较,差异无统计学意义(χ2=0.170,P=0.918)。结论:对于胸腰椎骨折患者,虽然椎旁肌间隙入路切口长度较长,但采用该入路进行椎弓根钉棒系统内固定手术,较经皮入路和传统后正中入路出血少、损伤小、恢复快,更有利于椎体高度和脊柱功能恢复,安全性高。
Abstract:
Objective:To compare the clinical curative effects and safety of three different surgical approaches in pedicle screw-rod system(PSRS)internal fixation for treatment of thoracolumbar fractures.Methods:One hundred and thirty-five patients with thoracolumbar fractures were randomly divided into posterior median approach group,percutaneous approach group and paraspinal approach group,45 cases in each group,and they were treated with PSRS internal fixation through three different surgical approaches respectively by the same surgeon.The incision length,operative time,intraoperative blood loss,hospital stay and fracture healing time were recorded.The ratio of anterior border height to posterior border height(APR)and kyphotic Cobb angle of injured vertebrae were measured,and the postoperative activities of daily living(ADL)were evaluated by using Oswestry disability index(ODI)before the surgery and at 3 months after the surgery respectively.The blood was drawn from the peripheral vein,and the serum levels of creatine kinase(CK),myoglobin(Myo)and lactate dehydrogenase(LDH)were detected by using enzyme linked immunosorbent assay(ELISA)before the surgery and on the day of the surgery respectively,and the postoperative complications were observed.Results:①There was statistical difference in incision length,operative time,intraoperative blood loss,hospital stay and fracture healing time between the 3 groups in general(7.96±0.85,2.11±0.56,12.13±3.94 cm,F=206.542,P=0.000; 94.87±9.32,66.72±8.49,53.58±9.97 minutes,F=180.208,P=0.000; 114.87±14.32,81.29±11.17,67.23±9.81 mL,F=189.815,P=0.000; 10.17±2.47,7.38±1.88,6.08±1.69 days,F=47.207,P=0.000; 5.85±1.17,5.16±1.02,4.30±0.89 months,F=25.429,P=0.000).The operative time,hospital stay and fracture healing time were shorter,and the intraoperative blood loss was less in percutaneous approach group and paraspinal approach group compared to posterior median approach group(P=0.000,P=0.000,P=0.002; P=0.000,P=0.000,P=0.000; P=0.000,P=0.000); and the operative time,hospital stay and fracture healing time were shortest,the intraoperative blood loss was least in paraspinal approach group(P=0.000,P=0.000,P=0.000; P=0.000).The incision length was shorter in percutaneous approach group compared to posterior median approach group and paraspinal approach group(P=0.000,P=0.000),and was longest in paraspinal approach group(P=0.000)...

参考文献/References:

[1] RAMíREZ-VILLAESCUSA J,HIDALGO J L T,RUIZ-PICAZO D,et al.The impact of urgent intervention on the neurologic recovery in patients with thoracolumbar frac-tures[J].J Spine Surg,2018,4(2):388-396.
[2] SALLAM A M,ABDEL GHANY W A,ALI A K,et al.Short-segment posterior fixation with index level screws versus long-segment posterior fixation for thoracolumbar spine fracture:angle of correction and pain[J].Egyptian Journal of Neurosurgery,2019,33:11.
[3] 何人可,曹杨.胸腰椎骨折后路手术治疗研究进展[J].国际骨科学杂志,2020,41(2):100-103.
[4] 祝乃强,侯静怡,马桂云,等.经皮椎弓根螺钉内固定治疗胸腰椎骨折[J].中国矫形外科杂志,2019,27(18):1663-1668.
[5] 冯炜炜,陈金,崔巍.微创经皮椎弓根螺钉内固定术治疗单椎体MagerlA型胸腰椎骨折患者的临床疗效[J].中国医师杂志,2020,22(3):407-411.
[6] 汪庚申,刘海军,黄国源,等.经皮与改良Wiltse入路置钉治疗胸腰椎骨折[J].中国矫形外科杂志,2020,28(4):364-368.
[7] 付忠泉,禤天航,霍智铭,等.胸腰椎损伤分类及损伤程度评分在胸腰椎椎体骨折微创手术预后评价中的应用[J].广东医学,2019,40(18):2682-2685.
[8] 蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:119-121.
[9] HUANG K Y,LEE S C,LIU W L,et al.Long term survival of pathological thoracolumbar fractures treated with vertebroplasty:analysis using a nationwide insurance claim database[J].J Clin Med,2019,9(1):78.
[10] 陈军平,邝立鹏,王国寿,等.经皮椎体成形术联合骨水泥强化经皮椎弓根螺钉固定对严重骨质疏松性胸腰椎压缩性骨折的疗效[J].广东医学,2019,40(24):3403-3408.
[11] 万永杰,娄茜华,郭永传.Wiltse入路经椎弓根椎体内植骨联合伤椎置钉治疗胸腰椎骨折的疗效[J].安徽医学,2020,41(12):1458-1460.
[12] 关海森,卫星,张军伟.经皮置钉与椎旁肌间隙入路置钉内固定手术治疗A型胸腰椎骨折的疗效及创伤指标对比[J].颈腰痛杂志,2020,41(5):612-614.
[13] 邹鹏,杨俊松,黄小强,等.小切口Wiltse入路椎弓根螺钉内固定术与经皮椎弓根螺钉内固定术治疗胸腰椎骨折的前瞻性对比研究[J].骨科,2020,11(5):450-452.
[14] CHANG J,CAO J,HUANG Z,et al.Comparison of the modified Wiltse’s approach with spinal minimally invasive system and traditional approach for the therapy of thoracolumbar fracture[J].J Biomed Res,2020,34(5):379-386.
[15] SHIN S R,LEE S S,KIM J H,et al.Thoracolumbar burst fractures in patients with neurological deficit:anterior approach versus posterior percutaneous fixation with laminotomy[J].J Clin Neurosci,2020,75:11-18.
[16] 张富国.微创经椎弓根植骨内固定术与传统开放手术治疗不稳定胸腰椎骨折对比研究[J].浙江创伤外科,2017,22(1):46-48.
[17] 叶盛开,陈海英,任霞,等.静脉补钙治疗骨质疏松症的疗效和安全性[J].临床药物治疗杂志,2019,17(10):46-51.
[18] 王长庚,杨德猛,陈媛.血液生化指标连续检测在创伤骨折中的应用价值[J].中国当代医药,2019,26(1):122-124.
[19] 李佳,王磊,刘伟,等.Wiltse间隙与经皮微创入路联合伤椎置钉治疗胸腰椎骨折[J].广东医学,2018,39(19):2921-2924.
[20] 解俊杰,李若飞,梁慧萍.两种手术入路在胸腰椎骨折伴脊髓损伤治疗中的效果比较[J].实用骨科杂志,2018,24(11):975-978.

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更新日期/Last Update: 1900-01-01