[1]于同,矫健航,姜炜博,等.体位复位与椎板切除减压内固定术治疗胸腰段爆裂性骨折的对比性研究[J].中华老年骨科与康复电子杂志,2024,(06):331-339.[doi:10.3877/cma.j.issn.2096-0263.2024.06.003]
　Yu Tong,Jiao Jianhang,Jiang Weibo,et al.Comparative study of postural reduction and internal fixation versus laminectomy reduction and internal fixation in the treatment ofthoracolumbar burst fractures[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2024,(06):331-339.[doi:10.3877/cma.j.issn.2096-0263.2024.06.003]
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体位复位与椎板切除减压内固定术治疗胸腰段爆裂性骨折的对比性研究()
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2024年06期
页码:
331-339
栏目:
脊柱专题
出版日期:
2024-12-05

文章信息/Info

Title:
Comparative study of postural reduction and internal fixation versus laminectomy reduction and internal fixation in the treatment ofthoracolumbar burst fractures
作者:
于同; 矫健航; 姜炜博; 王中汉; 王洋; 伍旭辉; 吴敏飞
130000长春，吉林大学第二医院骨科医学中心
Author(s):
Yu Tong;  Jiao Jianhang;  Jiang Weibo;  Wang Zhonghan;  Wang Yang;  Wu Xuhui;  Wu MinFei.
Orthopaedic Medical Centre, The Second Hospital of Jilin University, Changchun 130000, China
关键词:
胸腰段爆裂性骨折;  脊髓损伤;  减压;  内固定
Keywords:
Thoracolumbarburst fracture;  Spinal cord injury;  Decompression;  Internal fixation
DOI:
10.3877/cma.j.issn.2096-0263.2024.06.003
文献标志码:
A
摘要:
目的 研究体位复位减压内固定术治疗胸腰段爆裂性骨折的有效性，并对比体位复位减压内固定术与椎板切除减压内固定术的临床疗效。方法 回顾性分析2016年6月至2020年12月在吉林大学第二医院骨科医学中心接受手术治疗的134名胸腰段爆裂性骨折患者。所有患者ASIA评分结果为C或D。根据手术方式不同，将患者分为A和B两组。A组（n=66例）：行体位复位减压内固定术治疗；B组（n=68例）：行椎板切除减压内固定术治疗。对比分析两组患者的手术时间、失血量、手术前、后伤椎前缘高度、矢状面Cobb角、ASIA评分、VAS评分、ODI评分和手术并发症。结果 134例患者平均随访时间为29.5±5.3个月；其中A组为24.4～34.5个月，B组为24.2～34.8个月；A组男37例，女29例，平均年龄（42.21±23.93）岁；B组男38例，女30例，平均年龄（46.80±27.47）岁。两组患者的一般情况无统计学差异（P＞0.05）；在术前和术后2年随访时，A组与B组相比，伤椎前缘高度丢失百分比分别为[（50.00±11.26）% vs.（46.26±14.50）%，P＞0.05]，[（13.74±3.33）% vs.（18.19±1.78）%，P＜0.05]，Cobb角分别为[（37.65±2.26）° vs.（37.13±1.59）°，P＞0.05]、[（12.38±1.25）° vs. （15.76±1.45）°，P＜0.05]，手术时间分别为[（51.36±5.65）min vs.（74.81±9.29）min，P＜0.001]，术中失血量分别为[（56.80±13.97）mL vs.（188.38±61.15）mL，P＜0.001]，术后3天的背部疼痛VAS评分结果为[（5.44±0.50）分vs.（6.49±0.50）分，P＜0.05]；两组间比较，术前、术后3天、术后1年和术后2年随访时ASIA评分、下肢疼痛VAS评分、ODI评分方面对比差异无统计学意义（P＞0.05）；但两组内比较，手术后均较术前明显改善（P＜0.05）。结论 体位复位减压内固定术和椎板切除减压内固定术都是治疗胸腰段爆裂性骨折的安全有效方法。但是，对于ASIA评分为C级和D级的胸腰椎爆裂性骨折患者而言，体位复位减压内固定术具有手术创伤小、手术时间短以及术后早期腰背部疼痛轻的优点。
Abstract:
Objective Laminectomy decompressionandpediclescrewinternal fixation is a commonly used technique for the treatment of spinal cord injuries caused by thoracolumbar burst fractures, but it has the disadvantage of high surgical trauma. Therefore, we evaluated the efficacy of postural reduction and internal fixation in the treatment of thoracolumbar burst fractures and compared the clinical efficacy of postural reduction internal fixation with laminectomy reduction internal fixation. Methods We retrospectively analysed 134 patients with thoracolumbar burst fractures who were surgically treated at the Orthopaedic Medical Centre of the Second Hospital of Jilin University between June 2016 to December 2020. All patients had an ASIA score of C or D. According to the operationmethods, patients were divided into two groups, A and B. Group A (n=66 patients): treated with postural repositioning decompression and internal fixation; Group B (n=68 patients): treated with laminectomy decompression and internal fixation. General condition, operative time, in traoperative blood loss, anterior height of injured vertebrae, sagittal Cobb angle, ASIA score, VAS sc-ore, ODI score and surgical complications were compared between the two groups. Results The average follow-up time of the 134 patients was 29.5±5.3 months, of which 24.4-34.5 months in group A and 24.2-34.8 months in group B. There were 37 males and 29 females in group A with an average age of 42.21±23.93 years and 38 males and 30 females in group B with an average age of 46.80±27.47 years. There was no statistical difference in the general condition of the patients in the two groups (P>0.05). At the preoperative and 2-year postoperative follow-up, the percentage height loss of the anterior margin of the injured vertebrae in group A and group B was [(50.00±11.26)% vs. (46.26±14.50)%, P>0.05], [(13.74±3.33)% vs. (18.19±1.78)%, P<0.05], the Cobb angle was [(37.65±2.26)° vs. (37.13±1.59)°, P>0.05], [(12.38±1.25)° vs. (15.76±1.45)°, P<0.05], and the operation time was [(51.36±5.65)min vs. (74.81±9.29) min, P<0.001], intraoperative blood loss was [(56.80±13.97) mL vs. (188.38±61.15) mL, P<0.001], and the results of the VAS score for back pain at 3 days postoperatively were [(5.44±0.50) vs. (6.49±0.50), P<0.05]. When comparing the two groups, there was no statistically significant difference in ASIA score, VAS score for lower limb pain and ODI score at preoperative, 3 days postoperative, 1 year postoperative and 2 years postoperative follow-up (P>0.05). However, all these scores were significantly improved after surgery compared to the preoperative when compared within the two groups (P<0.05). Conclusions Both postural reduction internal fixation and laminectomy reduction internal fixation are safe and effective procedures for the treatment of thoracolumbar burst fractures. However, for patients with thoracolumbar burst fractures with ASIA scores of C and D, postural reduction internal fixation has the advantages of less surgical trauma, shorter operative time, and less back painin the early postoperative period.

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备注/Memo

备注/Memo:
基金项目：吉林省高教科研课题（JGJX2021D28）大学生创新创业训练计划（202210183323）
更新日期/Last Update: 2025-03-10