论文部分内容阅读
目的:探讨后路前凸弯棒预加压复位固定技术治疗胸腰段不稳定性爆裂骨折的安全性和有效性。方法:2017年7月至2019年12月，依据2019 AOSpine-Spine Trauma Classification System分型标准，33例A3型、伤椎节段后凸角度>20°、ASIA分级E级的胸腰段骨折患者采用后路前凸弯棒预加压复位固定技术治疗。所有患者均为单椎体骨折，手术均采用后路前凸弯棒预加压固定复位技术，采用3组椎弓根螺钉固定伤椎及伤椎邻近上、下位椎体并对伤椎进行复位，术中均未进行植骨融合。主要观察指标为患者手术前后的伤椎中柱高度、伤椎骨块侵入面积、伤椎椎管侵占率，以及术前、术后及末次随访时的节段后凸角、疼痛视觉模拟评分（visual analogue scale，VAS）及Oswestry功能障碍指数（oswestry disability index，ODI），采用n t检验进行统计学分析。n 结果:33例患者手术均获成功，共置入198枚椎弓根螺钉，术后CT评估置钉准确率为98.8%。手术时间为（89.8±20.4）min，术中出血量为（170±53.7）ml。中柱高度由术前（17.32±2.02）mm改善至术后（21.41±3.68）mm；伤椎骨块侵入面积由术前的（101.3±21.67）mmn 2改善至术后（68.5±18.2）mmn 2。伤椎椎管侵占率由术前的47.66%±19.83%改善至术后19.61%±5.75%。伤椎节段后凸角由术前的26.33°±5.68°改善至术后的3.13°±1.25°，末次随访时为3.49°±1.89°。VAS评分由术前（6.42±1.25）分改善至术后（1.85±0.71）分，末次随访时为（1.69±1.21）分。ODI由术前43.03%±3.46%改善至术后21.88%±4.22%，末次随访时为6.33%±2.31%。各观察指标术后及末次随访时与术前比较差异均有统计学意义（n P 20° and Asia Grade E were treated with anterior-curved rod and precompressive reduction and fixation from posterior approach. All the patients had single vertebral fractures. Three groups of screws were used to fix the injured vertebrae and the upper and lower vertebrae adjacent to the injured vertebrae, and the injured vertebrae were reduced. No bone graftor fusion was performed during the operation. The main outcome measures were the height of middle column of the injured vertebrae, the invaded cross-area of the injured vertebral canal, the encroachment rate of the injured vertebral canal, the Cobb angle of kyphosis, and visual analogue scale (VAS) and Oswestry disability index (ODI) before and after operation and at the last follow-up. All these data were analyzed statistically by n t-test.n Results:The operation was successfully performed in all 33 patients. 198 pedicle screws were implanted. The accuracy ofthe screws by CT evaluation was 98.8%. The average operation time was 89.8±20.4 min, and the average intraoperative blood loss was 170±53.7 ml. The height of the middle column was improved from 17.32±2.02 mm preoperatively to 21.41±3.68 mm postoperatively, and the invaded cross-area of the injured vertebral canal was improved from 101.3 ± 21.67mm2 before operation to 68.5±18.2 mmn 2 after operation. The encroachment rate of the injured vertebral canal was improved from 47.66% ± 19.83% before operation to 19.61%±5.75% after operation; Cobb angle of kyphosis was improved from 26.33°±5.68° before operation to 3.13°±1.25° after operation; VAS score was improved from 6.42±1.25 before operation to 1.85±0.71 after operation, and 1.69±1.21 at the last follow-up; ODI was improved from 43.03%±3.46% before operation to 21.88%±4.22% after operation and 6.33%±2.31% at the last follow-up. There were statistically significant differences in the observative indexes after operation and at the last follow-up compared with those before the operation (P < 0.05).n Conclusion:The technique of anterior-curved rod and precompressive reduction and fixation from posterior approach can safely and effectively reduce both the invading bone mass within the injured vertebral canal and the kyphosis angle.