摘要
目的 对比分析经伤椎与跨伤椎短节段椎弓根钉内固定治疗脊柱骨折的临床疗效.方法 选取2019 年 6 月至 2021 年 6 月河南省第二人民医院收治的 118 例脊柱骨折患者作为研究对象,按照不同手术方式将其分为观察组(59 例)和对照组(59 例),观察组患者采用经伤椎短节段椎弓根钉内固定治疗,对照组患者采用跨伤椎短节段椎弓根钉内固定治疗,对比观察两组患者围手术期相关情况、临床疗效以及椎体解剖结构恢复情况、椎体功能与生存质量.结果 观察组患者术中出血量、手术时间及住院时间与对照组均无明显差异(t=0.731、0.722、0.585,P=0.467、0.472、0.560);术后 12 个月,观察组患者显效 45 例、有效 13 例、无效 1例,明显优于对照组患者的显效 33 例、有效 23 例、无效 3 例(Z=-2.358,P=0.018);术后 12 个月,观察组患者Cobb角、椎体前缘高度压缩率、椎体后缘高度压缩率及椎管占位率均明显小于对照组(t=10.670、9.967、11.720、7.632,P均＜0.001);术后 12 个月,观察组患者改良Oswestry功能障碍指数(ODI)评分明显低于对照组,WHO生存质量测定量表简表(WHOQOL-BREF)评分明显高于对照组(t=18.251、16.833,P均＜0.001).结论 经伤椎短节段椎弓根钉内固定能更好地矫正脊柱骨折患者椎体解剖结构,促进椎体功能恢复,提高患者生活质量,临床推广应用价值更高.
Abstract
Objective To compare the clinical efficacy of short-segment pedicle screw fixation in trans-injured vertebral and cross-injured vertebral approaches in treating spinal fractures.Methods 118 patients with spinal fractures admitted to The Second People's Hospital of Henan Province from June 2019 to June 2021 were enrolled as research subjects and divided,according to the surgical methods they received,into the study group(n=59)and the control group(n=59).Patients in the study group were treated with short-segment pedicle screw fixation in the trans-injured vertebral approach,whereas patients in the control group were treated with short-segment pedicle screw fixation in the cross-injured vertebral approach.The following indicators of patients were compared between the two groups,including perioperative related indicators,clinical efficacy,recovery of vertebral anatomical structure,vertebral function,and quality of life.Results There were no statistically significant differences between the two groups in terms of intraoperative blood loss,operation time,and length of stay(t=0.731,0.722 and 0.585,P=0.467,0.472 and 0.560).Twelve months after surgery,45 cases were markedly effective,13 cases were effective,and 1 case was ineffective in the study group,much better than the control group(Z=-2.358,P=0.018)-33 cases markedly effective,23 cases effective,and 3 cases ineffective.Twelve months after surgery,the Cobb angle,the height of anterior vertebral compression rate,the height of posterior vertebral compression rate and the spinal canal occupation rate of patients were obviously more minor in the study group compared with the control group(t=10.670,9.967,11.720 and 7.632,all P＜0.001),the score of the improved Oswestry disability index(ODI)of patients was significantly lower in the study group compared with the control group,and the WHO quality of life-BREF(WHOQOL-BREF)scores of patients were obviously higher in the study group(t=18.251 and 16.833,both P＜0.001).Conclusion Short-segment pedicle screw fixation in the trans-injured vertebral approach can better correct the vertebral anatomical structure of patients with spinal fracture,promote their vertebral function recovery,and improve their quality of life,presenting high value of clinical application.
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