文章摘要
蔡弢艺,陈志达,张哲明,等.后路体位复位联合椎弓根钉撑开复位固定治疗A3、A4型胸腰椎骨折的疗效对比.骨科,2023,14(6): 495-500.
后路体位复位联合椎弓根钉撑开复位固定治疗A3、A4型胸腰椎骨折的疗效对比
Comparison of Curative Effects of Posterior Posture Reduction Combined with Pedicle Screw Distraction Reduction and Fixation for Treatment of A3 and A4 Type Thoracolumbar Fractures
投稿时间:2023-05-14  
DOI:10.3969/j.issn.1674-8573.2023.06.002
中文关键词: 胸腰椎骨折  体位复位  分型  内固定  疗效  对比研究
英文关键词: Thoracolumbar fracture  Posture reduction  Classification  Internal fixation  Curative effect  Comparative study
基金项目:福建省自然科学基金(2021J01546);全军军事训练伤防治研究专项(21XLS23)
作者单位E-mail
蔡弢艺 中国人民解放军联勤保障部队第九〇九医院(厦门大学附属东南医院)全军骨科中心福建漳州 363000  
陈志达 中国人民解放军联勤保障部队第九〇九医院(厦门大学附属东南医院)全军骨科中心福建漳州 363000 czd5320@163.com 
张哲明 中国人民解放军联勤保障部队第九〇九医院(厦门大学附属东南医院)全军骨科中心福建漳州 363000  
林斌 中国人民解放军联勤保障部队第九〇九医院(厦门大学附属东南医院)全军骨科中心福建漳州 363000  
蒋元杰 中国人民解放军联勤保障部队第九〇九医院(厦门大学附属东南医院)全军骨科中心福建漳州 363000  
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中文摘要:
      目的 对比后路体位复位联合椎弓根钉撑开复位固定治疗A3、A4型胸腰椎骨折的疗效。方法 回顾性分析我院2019年1月至2021年12月采用后路体位复位联合椎弓根钉撑开复位固定治疗的66例A3、A4型胸腰椎压缩骨折病人的临床及影像学资料。其中男40例,女26例,(48.14±5.73)岁(26~60岁)。A3型骨折37例纳入A3组,A4型骨折29例纳入A4组。采用疼痛视觉模拟量表(VAS)评分与Oswestry功能障碍指数(ODI)评估手术临床效果,比较两组伤椎前缘高度比、伤椎后凸角及局部后凸Cobb角等。结果 病人随访11~18个月,术后切口均一期愈合,未见感染、神经损伤、内固定失效等并发症。两组术后随访VAS评分、ODI指数均较术前明显改善,差异有统计学意义(P<0.05),但组间差异无统计学意义(P>0.05)。A3组术后3天的伤椎前缘高度比、伤椎后凸角分别为89.14%±4.79%、6.67°±2.13°,均较术前显著改善,且显著优于A4组的85.72%±5.17%、8.36°±2.49°,在随访期内,各项数值均显著优于术前,且组间比较,差异均有统计学意义(P<0.05)。两组术后及随访期内,局部后凸Cobb角均较术前显著改善,但组间差异并无统计学意义(P>0.05)。结论 后路体位复位联合椎弓根钉撑开复位固定治疗A3、A4型胸腰椎骨折均能取得良好的临床疗效,且A3型骨折在伤椎前缘高度比、伤椎后凸角改善方面均优于A4型骨折。
英文摘要:
      Objective To compare the curative effects of posterior posture reduction combined with pedicle screw distraction reduction and fixation for treatment of A3 and A4 type thoracolumbar fractures. Methods We retrospectively analyzed the clinical and imaging data of 66 patients with thoracolumbar compression fractures of AO Spine type A3 and A4 treated with posterior posture reduction combined with pedicle screw distraction reduction and fixation who were admitted to our hospital from January 2019 to December 2021, including 40 males and 26 females, aged (48.1±5.73) years old (26-60 years). A total of 37 cases of A3 type fractures were included in the A3 group, and 29 cases of A4 type fractures were included in the A4 group. Clinical outcome was evaluated with visual analogue scale (VAS) and Oswestry disability index (ODI). The percentage of anterior vertebral body height, lordosis of the injured vertebral body and the Cobb angle of local lordosis were measured. Results All patients were followed up for a period of 11 to 18 months. All patients healed well after surgery, and no infection, nerve injury, or internal fixation failure occurred. The VAS score and ODI in the two groups during postoperative follow-up were significantly improved compared to those before surgery (P<0.05), however, there was no statistically significant difference between the two groups (P>0.05). The percentage of anterior vertebral body height and lordosis of the injured vertebral body in the A3 group were 89.14%±4.79% and 6.67°±2.13° at 3rd day after surgery, which were significantly improved compared to those before surgery and significantly better than 85.72%±5.17% and 8.36°±2.49° in the A4 group. During the follow-up period, all values were significantly better than before surgery, and the differences between groups were statistically significant (P<0.05). After surgery and during the follow-up period, the Cobb angle of local lordosis in both groups was significantly improved compared to before surgery, but there was no statistically significant difference between the groups (P>0.05). Conclusion Posterior posture reduction combined with pedicle screw distraction reduction and fixation can achieve good clinical efficacy in the treatment of A3 and A4 type thoracolumbar fractures, while A3 type thoracolumbar fractures are superior to A4 type fractures in terms of the percentage of anterior vertebral body height and the Cobb angle of local lordosis.
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