实用医学杂志 ›› 2022, Vol. 38 ›› Issue (12): 1465-1469.doi: 10.3969/j.issn.1006⁃5725.2022.12.005

• 专题报道 • 上一篇    下一篇

经伤椎与跨伤椎椎弓根螺钉内固定对胸腰椎爆裂性骨折患者的疗效及生物力学特征

赵锦胜 曹汉岐 杨寒石    

  1. 淮安市第二人民医院(江苏淮安 223002)

  • 出版日期:2022-06-25 发布日期:2022-06-25

Effect and biomechanical characteristics of transforaminal and straddling pedicle screw internal fixation in patients with thoracolumbar burst fractures and biomechanical characteristics

ZHAO Jinsheng,CAO Han⁃ qi,YANG Hanshi.   

  1. Huai′an Second People′s Hospital,Huai′an 223002,China

  • Online:2022-06-25 Published:2022-06-25

摘要:

目的 对比经伤椎与跨伤椎椎弓根螺钉内固定在胸腰椎爆裂性骨折患者中的疗效及生物力学特性。方法 86 例胸腰椎爆裂性骨折患者随机分为经伤椎组与跨伤椎组,分别给予经伤椎与跨伤椎椎弓根螺钉内固定治疗,术后均随访 2 年。对比疼痛、Oswestry 功能障碍指数(ODI)、影像学指标及术后 并发症、切口愈合、骨折愈合等。另通过生物力学试验比较两组生物力学特性。结果 两组疼痛视觉模 拟量表(VAS)、ODI 评分在术前、术后 3 个月、末次随访时均依次下降(P < 0.05),术后即刻、术后 3 个月、末次随访时伤椎压缩率、后凸畸形 Cobb 角均低于术前(P < 0.05),除 VAS 外,经伤椎组术后 3 个月、末次随访时上述指标均低于跨伤椎组(P < 0.05);两组术后均无并发症发生,切口均甲级愈合,骨折均愈合;经伤椎 组扭转角度、后屈位移、前屈位移及拔出强度低于跨伤椎组(P < 0.05)。结论 对胸腰椎爆裂性骨折患者 采用经伤椎与跨伤椎椎弓根螺钉内固定治疗均可获得良好的临床疗效,但经伤椎椎弓根螺钉内固定的临 床应用价值更佳。

关键词:

胸腰椎爆裂性骨折, 椎弓根螺钉内固定, 临床效果, 生物力学 ,

Abstract:

Objective To compare the effect of transforaminal and straddling pedicle screw internal fixation in patients with thoracolumbar burst fractures. Methods A total of 86 patients with thoracolumbar burst fractures were randomly divided into traumatic vertebral group and straddling vertebra group and were treated with transpe⁃ dicular screw fixation and straddling vertebra pedicle screw internal fixation,respectively,and were followed up for 2 years. The pain,Oswestry dysfunction index(ODI),imaging index and postoperative complications,incision healing and fracture healing were compared. In addition,the biomechanical characteristics of the 2 groups were compared by biomechanical test. Results The scores of pain visual analogue scale(VAS)and ODI in the two groups were decreased successively at completion of operation,3 months after operation and the last follow ⁃ up (P < 0.05),and the compression rate of injured spine and Cobb angle of kyphosis at completion of operation,3 months after operation and the last follow⁃up were lower than before operation(P < 0.05). However,except VAS the above indexes in traumatic vertebra group at 3 months after operation and the last follow ⁃ up were lower than those in straddling vertebra group(P < 0.05). There were no postoperative complications in both groups after operation,and the incision healed in Grade A and the fracture healed in both groups. The torsion angle,flexion displacement,flexion displacement and pullout strength in the traumatic vertebral group were lower than those in the straddling vertebral group(P < 0.05). Conclusion For patients with thoracolumbar burst fractures,the strad⁃ dling screw fixation and transpedicular screw fixation all could obtain good clinical efficacy,while transpedicular screw fixation had better clinical application value.

Key words:

thoracolumbar burst fracture, pedicle screw internal fixation, clinical effect, biome? chanical properties