过伸牵引弹性按压联合经皮椎弓根螺钉治疗单节段胸腰椎骨折疗效分析

汪东; 牛国旗; 鲍正齐; 吴一凡; 王金子; 刘路坦; 周乾坤

doi:10.13898/j.cnki.issn.1000-2200.2023.07.009

过伸牵引弹性按压联合经皮椎弓根螺钉治疗单节段胸腰椎骨折疗效分析

Effect comparison between hyperextension traction elastic compression combined with percutaneous pedicle screw in the treatment of single level thoracolumbar fracture

摘要

摘要:
目的分析过伸牵引弹性按压联合经皮椎弓根螺钉与传统后路椎弓根螺钉内固定治疗单节段胸腰椎骨折的手术创伤与临床疗效。
方法回顾性分析46例胸腰椎骨折病人的资料，按照治疗方式不同分为过伸牵引弹性按压联合经皮置钉组(经皮置钉组)24例和传统切开组22例，观察指标包括：椎体前缘高度变化、Cobb角变化、切口长度、术中出血量、手术时间、术后住院时间及术前术后疼痛等级评分法(VAS)评分、术后日本骨科协会评估治疗分数(JOA)评分、Oswestry功能障碍指数(ODI)评分。
结果经皮置钉组病人与传统切开组病人相比，其切口长度、手术时间、术中出血量、术后住院时间均相对减少(P < 0.05)；2组病人术后的矢状面后凸Cobb角均较术前降低(P < 0.05)；伤椎椎体前缘高度较术前均升高(P < 0.05)；术后1周、6个月VAS评分较术前均降低(P < 0.05)。但术后6个月，经皮置钉组VAS评分、ODI评分均较传统切开组低(P < 0.05)，术后JOA评分较传统切开组高(P < 0.05)。
结论过伸牵引弹性按压联合经皮椎弓根螺钉内固定治疗胸腰椎骨折临床疗效肯定，具有创伤小、出血少、术后功能恢复快等优点，可为胸腰椎骨折病人提供一种稳定可靠的治疗手段。

Abstract:
ObjectiveTo compare the effects of hyperextension traction elastic compression combined with percutaneous pedicle screw with traditional posterior incision pedicle screw internal fixation in the treatment of single level thoracolumbar fracture.
MethodsThe clinical data of 46 patients with thoracolumbar fracture were retrospectively analyzed.According to different treatment methods, the patients were divided into the hyperextension traction elastic compression combined with percutaneous screw placement group(24 cases) and traditional incision group(22 cases).The anterior vertebral edge height change, Cobb angle change, incision length, intraoperative blood loss, operative time, postoperative hospital stay, preoperative and postoperative visual analogue scale(VAS) scores, postoperative Japanese Orthopaedic Association (JOA) score and Oswestry disability index(ODI) score were compared between two groups.
ResultsCompared with the traditional incision group, the incision length, operation time, intraoperative blood loss and postoperative hospital stay in the percutaneous screw placement group reduced (P < 0.05).The Cobb angle of sagittal kyphosis in two groups decreased after surgery (P < 0.05).The anterior margin height of injured vertebrae was significantly higher than that before surgery (P < 0.05).The VAS scores at 1 week and 6 months after surgery were significantly lower than those before surgery (P < 0.05).After 6 months of surgery, the VAS and ODI scores in the percutaneous screw placement group were lower than those in the traditional incision group (P < 0.05), and the postoperative JOA score in the percutaneous screw placement group was higher than those in the traditional incision group (P < 0.05).
ConclusionsHyperextension traction elastic compression combined with percutaneous pedicle screw internal fixation in the treatment of thoracolumbar fracture has definite clinical efficacy, which has the advantages of less trauma, less bleeding, quick postoperative functional recovery, etc., and can provide a stable and reliable treatment for thoracolumbar fracture patients.

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