经伤椎单侧置钉与双侧置钉治疗胸腰椎骨折的疗效对比

发布时间：2018-10-10 10:53

【摘要】：目的:通过比较经伤椎单侧置钉与双侧置钉两种不同置钉方式在治疗胸腰椎骨折中手术时间、术中出血量、住院费用及临床疗效间的差异,探讨胸腰椎骨折患者最适宜置钉数目。方法:采用回顾性分析的方法,收集合肥市第一人民集团医院创伤骨科2012年9月~2015年9月收治的单个椎体无脊髓神经功能损伤的胸腰椎骨折患者的临床资料。根据伤椎置钉方式的不同将患者随机的分为单侧置钉组(A组)和双侧置钉组(B组)。所有研究方式和目的均已征得患者同意,两组患者均由同组医生行切开复位内固定术。分别统计两组患者的手术时间、术中出血量、住院费用;比较伤椎椎体前缘高度比、矢状位Cobb角度数及术后疼痛视觉模拟评分(VAS)之间的差异。所得数据采用统计学软件SPSS17.0软件进行统计学分析,不同时间点数据的相互比较懫用重复测量设计资料的方差检验进行分析,两组间计量资料比较采用t检验,计数资料及率的比较采用卡方检验。结果:本次研究共收集符合纳入、排除标准的病例42例,其中男性患者共有23人,女性患者共有19人,年龄20~60岁,平均年龄为42岁;其中车祸伤患者共有15人,摔伤病人共有15人,重物砸伤病人共有9人,高处坠落伤患者共有13人,所获得病例均获得随访。A组的22例患者中,平均手术时间为(120.77±11.21)min;平均术中出血量为(337.86±8.19)ml;平均住院费用为(28295.68±1373.74)元。B组的20例患者中,平均手术时间为(142.25±18.01)min,术中平均出血量为(382.20±7.45)ml,平均住院费用为(34789.35±1257.56)元。经统计学分析后,差异有统计学意义。A组平均疼痛评分(VAS):术前(7.43±0.92),术后3天(2.32±0.42),术后1年(1.14±0.38);B组平均疼痛评分(VAS):术前(7.23±1.10),术后3天(2.58±0.41),术后1年(1.25±0.26)。经统计学分析,两组在术前、术后3天及术后1年的比较,差异均无统计学意义(P0.05)。A组伤椎椎体前缘平均高度比:术前(54.50±6.49)%,术后3天(95.38±0.93)%,术后1年(92.45±1.32)%,取钉后3个月(89.55±0.65)%;矢状位平均Cobb角:术前(24.57±2.62)°,术后3天(2.26±0.57)°,术后1年(4.14±0.70)°,取钉后3个月(5.25±0.65)°。B组伤椎椎体前缘平均高度比:术前(56.50±5.92)%,术后3天(95.24±0.79)%,术后1年(92.35±1.06)%,取钉后3个月(89.85±0.59)%。矢状位平均Cobb角:术前(24.45±2.85)°,术后3天(2.43±0.47)°,术后1年(4.12±0.71)°,取钉后3个月(5.45±0.59)°。经统计学分析,两组间伤椎椎体前缘高度比、矢状位Cobb角组间相比较,差异均无统计学意义(p0.05);两组间伤椎椎体前缘高度比、矢状位Cobb角等影像学指标的组内相比较,各个时间点之间的差异均有统计学意义(P0.05)。结论:在符合本研究收集标准的研究对象中,经伤椎行单侧置钉与双侧置钉临床疗效无差别。经伤椎单侧置钉能够减少术中出血量,缩短手术时间,减少患者住院费用,具有较好的社会效益。
[Abstract]:Objective: to compare the difference of operation time, intraoperative bleeding amount, hospitalization cost and clinical effect between unilateral and bilateral screw insertion in the treatment of thoracolumbar fractures. To investigate the most suitable number of nails in patients with thoracolumbar fractures. Methods: retrospective analysis was used to collect the clinical data of patients with thoracolumbar fracture without spinal cord function injury treated in Department of Orthopedic Trauma of the first people's Group Hospital of Hefei from September 2012 to September 2015. Patients were randomly divided into unilateral nail group (group A) and bilateral nail group (group B). All the methods and purposes of the study were approved by the patients, and the two groups were treated with open reduction and internal fixation. The time of operation, the amount of intraoperative bleeding, the cost of hospitalization, the ratio of anterior edge height of injured vertebra, the number of sagittal Cobb angles and the visual analogue score (VAS) of postoperative pain were compared between the two groups. The data were analyzed by statistical software SPSS17.0, the data of different time points were compared with the variance test of repeated measurement design data, and the t test was used to compare the measured data between the two groups. The counting data and rate were compared by chi-square test. Results: a total of 42 cases, including 23 male patients and 19 female patients, with an average age of 42 years (20 ~ 60 years old), were collected. A total of 15 patients were injured, 9 were injured by heavy objects, and 13 were injured by falling from a height. All the cases were followed up in group A (22 cases). The mean operative time was (120.77 卤11.21) min;, the average intraoperative bleeding volume was (337.86 卤8.19) ml;, the average hospitalization cost was (28295.68 卤1373.74) yuan. The average operation time was (142.25 卤18.01) min, the average intraoperative bleeding volume was (382.20 卤7.45) ml, the average hospitalization cost was (34789.35 卤1257.56) yuan. After statistical analysis, the average pain score of group A was (7.43 卤0.92) before operation, (2.32 卤0.42) days after operation, (1.14 卤0.38) years after operation, and (7.23 卤1.10) before (VAS):, (2.58 卤0.41) days after operation, and (1.25 卤0.26) year after operation. By statistical analysis, the two groups were compared before operation, 3 days after operation and 1 year after operation. There was no significant difference between the two groups (P0.05). The average height ratio of the injured vertebrae in group A was (54.50 卤6.49) before operation, (95.38 卤0.93) days after operation (95.38 卤0.93), (92.45 卤1.32) in 1 year after operation, 3 months after nail removal (89.55 卤0.65), (24.57 卤2.62) 掳before operation, (2.26 卤0.57) 掳on 3 days after operation, (4.14 卤0.70) 掳after operation, 3 months after nail removal, and (24.57 卤2.62) 掳before operation, (2.26 卤0.57) 掳after operation, (4.14 卤0.70) 掳after operation, and (89.55 卤0.65) months after nail removal. In group B (5.25 卤0.65) 掳路B, the average height ratio of the injured vertebrae was (56.50 卤5.92) before operation, (95.24 卤0.79) days after operation, (92.35 卤1.06) at 1 year after operation, and (89.85 卤0.59) months after nail removal. The average sagittal Cobb angle was (24.45 卤2.85) 掳before operation, (2.43 卤0.47) 掳on 3 days after operation, (4.12 卤0.71) 掳at 1 year after operation, and (5.45 卤0.59) 掳at 3 months after nail removal. There was no significant difference in anterior height ratio of vertebral body and sagittal Cobb angle between the two groups (p0. 05), and there was no significant difference between the two groups (p0. 05), and there was no significant difference between the two groups in imaging indexes such as anterior height ratio of vertebral body and Cobb angle in sagittal position. The differences between each time point were statistically significant (P0.05). Conclusion: there is no difference in clinical efficacy between unilateral and bilateral screw placement in injured vertebrae. Unilateral screw insertion through injured vertebrae can reduce the amount of intraoperative bleeding, shorten the operation time, and reduce the cost of hospitalization. It has good social benefits.
【学位授予单位】：安徽中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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