摘要
目的 探讨脊柱骨折复位器推顶复位新技术治疗A3N0/1型胸腰椎骨折的疗效.方法 回顾性分析2019年1月至2022年1月在郑州市骨科医院微创脊柱外科接受手术治疗的53例A3N0/1型胸腰椎骨折患者资料.所有患者均采用经Wiltse入路内固定并经伤椎椎弓根植骨.男35例,女18例;年龄(37.8±10.2)岁.损伤节段:胸椎23例,腰椎30例.受伤至手术时间(3.3±1.5)d.根据术中是否使用脊柱骨折复位器将患者分为A组(23例,术中椎弓根螺钉撑开复位后,使用脊柱骨折复位器对伤椎进行推顶复位)和B组(30例,单纯使用椎弓根螺钉撑开复位).比较分析两组患者手术时间、术中出血量及并发症情况,比较两组患者术前、术后3个月、末次随访时伤椎椎体前缘高度百分比(AVBHr)、伤椎椎体中央高度百分比(MVBHr)、伤椎椎体后缘高度百分比(PVBHr)、伤椎局部Cobb角、疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI).结果 两组患者术前一般资料比较差异均无统计学意义(P＞0.05),具有可比性.所有患者术后获(16.3±5.9)个月随访,术后切口均为一期愈合,均无相关并发症发生.A组患者的手术时间较B组长[(115.1±16.6)min vs.(101.0±11.5)min],术中出血量较 B 组多[(136.5±17.0)mL vs.(121.6±19.8)mL],术后 3 个月 A 组患者的MVBHr(93.9％±4.0％)显著优于B组(83.3％±7.6％),末次随访时A组患者的MVBHr、AVBHr、Cobb 角、疼痛 VAS 评分、ODI 指数[86.6％±5.5％、89.8％±4.1％、4°(4°,6°)、1(0,1)分、4.7％±2.0％]均显著优于 B 组[78.0％(74.0％,79.0％)、84.5％±4.9％、12.2°±3.3°、2(1,3)分、7.3％±2.7％],以上项目两组间比较差异均有统计学意义(P＜0.05).但术后3个月及末次随访时两组PVBHr比较差异均无统计学意义(P＞0.05).结论 对于胸腰椎A3N0/1型骨折,脊柱骨折复位器推顶复位新技术可直接、有效地复位伤椎骨折区域,有利于维持术后椎体复位,减少后期的椎体高度丢失及后凸畸形的发生,并缓解腰部疼痛和改善腰椎功能.
Abstract
Objective To evaluate the clinical efficacy of pushing reduction with our self-designed spinal fracture reduction device in the treatment of A3N0/1 thoracolumbar fractures.Methods A retro-spective study was conducted to analyze the medical records of 53 patients who had undergone surgery for thora-columbar vertebrae fracture at Department of Minimally Invasive Spine Surgery,Zhengzhou Orthopedic Hospital from January 2019 to January 2022.All patients were treated by internal fixation via the Wiltse approach and bone grafting through the pedicle of the injured vertebrae.Clinical data:35 males and 18 females;age:(37.8±10.2)years;injured segments:23 cases at the thoracic spine and 30 cases at the lumbar spine;time from injury to surgery:(3.3±1.5)days.According to whether our self-designed spinal fracture reduction de-vice was used or not,the patients were assigned into group A(23 cases)in which the injured vertebrae were pushed and reduced using our novel spinal fracture reduction device after vertebral distraction reduction by the pedicle screw and group B(30 cases)in which the injured vertebrae were distracted and reduced using the pedicle screw alone.The operation time,intraoperative blood loss and complications were compared between the 2 groups.The anterior vertebral body height ratio(AVBHr),middle vertebral body height ratio(MVBHr),posterior vertebral body height ratio(PVBHr),Cobb angle of the injured vertebra,visual analogue scale(VAS)and Oswestry disability index(ODI)at preoperation,postoperative 3 and 6 months,and the last fol-low-up were compared between the 2 groups.Results There was no statistically significant difference in the preoperative general data between the 2 groups,indicating comparability(P＞0.05).All patients were followed up for(16.3±5.9)months.All incisions healed at one stage postoperatively without any related com-plications.The operation time in group A was significantly longer than that in group B[(115.1±16.6)min.versus(101.0±11.5)min.],the intraoperative blood loss in group A was significantly greater than that in group B[(136.5±17.0)mL versus(121.6±19.8)mL],the MVBHr at postoperative 3 months in group A(93.9％±4.0％)was significantly better than that in group B(83.3％±7.6％),and the MVBHr,AVBHr,Cobb angle,VAS,and ODI at the last follow-up in group A[86.6％±5.5％,89.8％±4.1％,4°(4°,6°),1(0,1)point,and 4.7％±2.0％]were significantly better than those in group B[78.0％(74.0％,79.0％),84.5％±4.9％,12.2°±3.3°,2(1,3)points,and 7.3％±2.7％](all P＜0.05).However,there was no statistically significant difference in PVBHr between the 2 groups at postoperative 3 months or at the last follow-up(P＞0.05).Conclusion In the treatment of A3N0/1 thoracolum-bar fractures,pushing reduction with our self-designed spinal fracture reduction device can directly and ef-fectively reduce the fracture zone of the injured vertebra,which is conducive to maintaining postoperative vertebral reduction,reducing vertebral height loss and kyphotic deformity at a later stage,relieving lumbar pain and improving lumbar spine function.
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