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[1]姚明鋒,蔣暉,潘育強(qiáng),等.3種不同手術(shù)入路椎弓根釘棒系統(tǒng)內(nèi)固定治療胸腰椎骨折的比較研究[J].中醫(yī)正骨,2021,33(10):16-22.
　YAO Mingfeng,JIANG Hui,PAN Yuqiang,et al.A comparative study of three different surgical approaches in pedicle screw-rod system internal fixation for treatment of thoracolumbar fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(10):16-22.
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3種不同手術(shù)入路椎弓根釘棒系統(tǒng)內(nèi)固定治療胸腰椎骨折的比較研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期數(shù):
2021年10期
頁碼:
16-22
欄目:
臨床研究
出版日期:
2021-10-20

文章信息/Info

Title:
A comparative study of three different surgical approaches in pedicle screw-rod system internal fixation for treatment of thoracolumbar fractures
作者:
姚明鋒; 蔣暉; 潘育強(qiáng); 戴龔成; 丁輝
(安吉縣第三人民醫(yī)院,浙江 安吉 313301)
Author(s):
YAO Mingfeng; JIANG Hui; PAN Yuqiang; DAI Gongcheng; DING Hui
The Third People’s Hospital of Anji County,Anji 313301,Zhejiang,China
關(guān)鍵詞:
脊柱骨折;  胸椎;  腰椎;  骨折固定術(shù); 內(nèi);  手術(shù)入路
Keywords:
spinal fractures;  thoracic vertebrae;  lumbar vertebrae;  fracture fixation;  internal;  operative approach
摘要:
目的:比較3種不同手術(shù)入路椎弓根釘棒系統(tǒng)內(nèi)固定治療胸腰椎骨折的臨床療效及安全性。方法:將135例胸腰椎骨折患者隨機(jī)分為后正中入路組、經(jīng)皮入路組及椎旁肌間隙入路組,每組45例。3組患者由同一主刀醫(yī)生進(jìn)行手術(shù),術(shù)中分別采用不同的手術(shù)入路植入椎弓根釘棒系統(tǒng),復(fù)位、固定骨折。記錄切口長度、手術(shù)時間、術(shù)中出血量、住院時間及骨折愈合時間。分別于術(shù)前和術(shù)后3個月,測量傷椎前后緣高度比和傷椎后凸Cobb角,采用Oswestry功能障礙指數(shù)(Oswestry disability index,ODI)評價患者術(shù)后行動能力與生活能力。觀察術(shù)后并發(fā)癥發(fā)生情況。分別于術(shù)前和術(shù)后當(dāng)天,抽取患者外周靜脈血,采用酶聯(lián)免疫吸附法測定血清肌酸激酶、肌紅蛋白和乳酸脫氫酶水平。結(jié)果:①一般結(jié)果。3組患者切口長度、手術(shù)時間、術(shù)中出血量、住院時間、骨折愈合時間組間總體比較,差異均有統(tǒng)計學(xué)意義[(7.96±0.85)cm,(2.11±0.56)cm,(12.13±3.94)cm,F=206.542,P=0.000;(94.87±9.32)min,(66.72±8.49)min,(53.58±9.97)min,F=180.208,P=0.000;(114.87±14.32)mL,(81.29±11.17)mL,(67.23±9.81)mL,F=189.815,P=0.000;(10.17±2.47)d,(7.38±1.88)d,(6.08±1.69)d,F=47.207,P=0.000;(5.85±1.17)個月,(5.16±1.02)個月,(4.30±0.89)個月,F=25.429,P=0.000]。經(jīng)皮入路組、椎旁肌間隙入路組患者手術(shù)時間、住院時間、骨折愈合時間均較后正中入路組短(P=0.000,P=0.000,P=0.002; P=0.000,P=0.000,P=0.000),術(shù)中出血量均較后正中入路組少(P=0.000,P=0.000)。椎旁肌間隙入路組患者手術(shù)時間、住院時間、骨折愈合時間均較經(jīng)皮入路組短(P=0.000,P=0.000,P=0.000),術(shù)中出血量較經(jīng)皮入路組少(P=0.000)。經(jīng)皮入路組患者切口長度較后正中入路組、椎旁肌間隙入路組短(P=0.000,P=0.000),后正中入路組患者切口長度較椎旁肌間隙入路組短(P=0.000)。②療效評價結(jié)果。術(shù)前3組患者傷椎前后緣高度比、傷椎后凸Cobb角、ODI組間總體比較,差異均無統(tǒng)計學(xué)意義[(62.15±7.31)%,(61.88±7.45)%,(62.54±6.97)%,F=0.094,P=0.910; 22.15°±1.77°,21.88°±1.55°,21.68°±1.38°,F=0.970,P=0.382;(35.62±2.32)%,(36.37±2.57)%,(35.98±2.11)%,F=1.155,P=0.318]。術(shù)后3個月,3組患者傷椎前后緣高度比、傷椎后凸Cobb角、ODI組間總體比較,差異均有統(tǒng)計學(xué)意義[(84.87±5.49)%,(89.91±4.63)%,(93.38±4.57)%,F=34.192,P=0.000; 7.55°±1.13°,6.43°±1.19°,5.69°±1.05°,F=28.234,P=0.000;(5.25±1.33)%,(4.53±1.17)%,(3.82±1.12)%,F=15.711,P=0.000]。經(jīng)皮入路組、椎旁肌間隙入路組患者傷椎前后緣高度比均較后正中入路組高(P=0.000,P=0.000),傷椎后凸Cobb角均較后正中入路組小(P=0.000,P=0.000),ODI均較后正中入路組低(P=0.008,P=0.000); 椎旁肌間隙入路組患者傷椎前后緣高度比較經(jīng)皮入路組高(P=0.000),傷椎后凸Cobb角較經(jīng)皮入路組小(P=0.002),ODI較經(jīng)皮入路組低(P=0.004)。③安全性評價結(jié)果。術(shù)前,3組患者血清肌酸激酶、肌紅蛋白、乳酸脫氫酶水平組間總體比較,差異均無統(tǒng)計學(xué)意義[(160.87±21.32)單位·L-1,(162.41±22.57)單位·L-1,(161.53±20.97)單位·L-1,F=0.057,P=0.944;(100.79±18.31)ng·mL-1,(103.19±17.37)ng·mL-1,(101.89±15.97)ng·mL-1,F=0.218,P=0.804;(108.38±18.77)單位·L-1,(111.36±16.35)單位·L-1,(113.81±17.08)單位·L-1,F=1.095,P=0.337]。術(shù)后當(dāng)天,3組患者血清肌酸激酶、肌紅蛋白、乳酸脫氫酶水平組間總體比較,差異均有統(tǒng)計學(xué)意義[(352.77±57.73)單位·L-1,(254.39±42.53)單位·L-1,(251.08±44.62)單位·L-1,F=63.193,P=0.000;(240.55±25.49)ng·mL-1,(192.53±19.63)ng·mL-1,(189.39±20.17)ng·mL-1,F=76.981,P=0.000;(190.55±21.43)單位·L-1,(163.23±19.19)單位·L-1,(160.33±20.21)單位·L-1,F=31.292,P=0.000]。經(jīng)皮入路組、椎旁肌間隙入路組3項指標(biāo)均較后正中入路組低(P=0.000,P=0.000,P=0.000; P=0.000,P=0.000,P=0.000),而這2組間比較,差異均無統(tǒng)計學(xué)意義(P=0.728,P=0.456,P=0.487)。后正中入路組術(shù)后并發(fā)切口感染2例、下肢深靜脈血栓2例、內(nèi)固定斷裂1例,經(jīng)皮入路組術(shù)后并發(fā)切口感染2例、下肢深靜脈血栓1例、內(nèi)固定斷裂1例,椎旁肌間隙入路組術(shù)后并發(fā)切口感染1例、下肢深靜脈血栓2例、內(nèi)固定斷裂1例; 3組患者并發(fā)癥發(fā)生率比較,差異無統(tǒng)計學(xué)意義(χ2=0.170,P=0.918)。結(jié)論:對于胸腰椎骨折患者,雖然椎旁肌間隙入路切口長度較長,但采用該入路進(jìn)行椎弓根釘棒系統(tǒng)內(nèi)固定手術(shù),較經(jīng)皮入路和傳統(tǒng)后正中入路出血少、損傷小、恢復(fù)快,更有利于椎體高度和脊柱功能恢復(fù),安全性高。
Abstract:
Objective:To compare the clinical curative effects and safety of three different surgical approaches in pedicle screw-rod system(PSRS)internal fixation for treatment of thoracolumbar fractures.Methods:One hundred and thirty-five patients with thoracolumbar fractures were randomly divided into posterior median approach group,percutaneous approach group and paraspinal approach group,45 cases in each group,and they were treated with PSRS internal fixation through three different surgical approaches respectively by the same surgeon.The incision length,operative time,intraoperative blood loss,hospital stay and fracture healing time were recorded.The ratio of anterior border height to posterior border height(APR)and kyphotic Cobb angle of injured vertebrae were measured,and the postoperative activities of daily living(ADL)were evaluated by using Oswestry disability index(ODI)before the surgery and at 3 months after the surgery respectively.The blood was drawn from the peripheral vein,and the serum levels of creatine kinase(CK),myoglobin(Myo)and lactate dehydrogenase(LDH)were detected by using enzyme linked immunosorbent assay(ELISA)before the surgery and on the day of the surgery respectively,and the postoperative complications were observed.Results:①There was statistical difference in incision length,operative time,intraoperative blood loss,hospital stay and fracture healing time between the 3 groups in general(7.96±0.85,2.11±0.56,12.13±3.94 cm,F=206.542,P=0.000; 94.87±9.32,66.72±8.49,53.58±9.97 minutes,F=180.208,P=0.000; 114.87±14.32,81.29±11.17,67.23±9.81 mL,F=189.815,P=0.000; 10.17±2.47,7.38±1.88,6.08±1.69 days,F=47.207,P=0.000; 5.85±1.17,5.16±1.02,4.30±0.89 months,F=25.429,P=0.000).The operative time,hospital stay and fracture healing time were shorter,and the intraoperative blood loss was less in percutaneous approach group and paraspinal approach group compared to posterior median approach group(P=0.000,P=0.000,P=0.002; P=0.000,P=0.000,P=0.000; P=0.000,P=0.000); and the operative time,hospital stay and fracture healing time were shortest,the intraoperative blood loss was least in paraspinal approach group(P=0.000,P=0.000,P=0.000; P=0.000).The incision length was shorter in percutaneous approach group compared to posterior median approach group and paraspinal approach group(P=0.000,P=0.000),and was longest in paraspinal approach group(P=0.000)...

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更新日期/Last Update: 1900-01-01