经伤椎置钉与跨伤椎置钉对胸腰椎骨折疗效的观察

发布时间：2019-04-24 08:21

【摘要】：目的：通过经伤椎置钉与跨伤椎置钉两种治疗方法对胸腰椎骨折病人术后影像学形态及相关因素恢复情况做对比,探讨不同的两种治疗方式对胸腰椎骨折形态变化及对应临床疗效分析。方法：收集我科室2010年3月至2014年3月,选取应用经伤椎置钉与跨伤椎置钉40例随访相对完整的胸腰椎骨折病人,将其分为实验组和对照组,其中实验组20例,对照组20例,两组患者术前椎体的高度(包括前缘和后缘)、受伤椎体节段的脊柱Cobb角和受伤部位疼痛程度组间无显著差异；实验组选用短节段的经伤椎置钉方法,对照组选用传统短节段跨伤椎置钉的方法,手术由同一术者和助手完成,钉棒系统材料均采购同一生产厂家,术后及随访均在同一台X阅片机打印出的片子上测量椎体高度(前缘和后缘),受伤节段脊柱Cobb角、钉棒系统形态及问询患者受伤部位疼痛程度(采用VAS评分法),对两组患者术前、术后及随访各项指标进行观察对比,同时结合患者腰背痛及功能恢复情况进行分析。包括：两组患者在术后4天、3月、6月、12月及取钉棒系统时(均在术后的14-16月取内固定)伤椎椎体前缘和后缘的高度、伤椎节段的脊柱Cobb角、钉棒系统完整情况以及两组患者术前、术后6月,取钉棒系统时伤部疼痛程度进行评估。结果：通过术前、术后及随访观察的相关数据对比分析得到以下结果：术后4天、3月,伤椎椎体高度(前缘、后缘)组间比较无统计学意义(P0.05)；术后到取钉棒系统时伤椎节段脊柱Cobb角均有统计学意义(P0.05)；术后6月到取钉棒系统时伤椎前缘高度组间比较有统计学意义(P0.05)；术后6月伤部疼痛程度组间比较无统计学意义(P0.05),取钉棒系统时伤部疼痛程度组间比较有统计学意义(P0.05),伤椎后缘高度术后在不同时间段比较均无统计学意义,随访发现跨伤椎组两例发生棒的断裂。结论：经伤椎置钉治疗脊柱胸腰椎骨折能更好恢复椎体前缘高度及矫正脊柱畸形,减少椎体高度丢失和钉棒系统失效,能减小病人受伤节段的慢性疼痛,其远期疗效确切,较传统跨伤椎置钉治疗比较其优势更大。
[Abstract]:Objective: to compare the imaging morphology and recovery of related factors in thoracolumbar fracture patients by two kinds of treatment methods: transected vertebral nail and trans-injured vertebral nail, and compared the imaging morphology and related factors of thoracolumbar fracture patients after operation. To explore the morphological changes of thoracolumbar fractures and the corresponding clinical effects of two different treatment methods. Methods: from March 2010 to March 2014, 40 patients with thoracolumbar spine fracture were selected and divided into two groups: experimental group (n = 20), control group (n = 20) and control group (n = 20), and the patients with thoracolumbar spine fracture were divided into experimental group (n = 20) and control group (n = 20). There was no significant difference between the two groups in the height of vertebral body (including the anterior and posterior edges), the spinal Cobb angle of the injured vertebral segment and the pain degree of the injured site. In the experimental group, the short-segment transected vertebral nail was used in the experimental group, and the traditional short-segment transposition nail was used in the control group. The operation was performed by the same operator and assistant, and the materials of the nail-rod system were all purchased from the same manufacturer. After operation and follow-up, the height of vertebral body (anterior edge and posterior edge), the Cobb angle of injured segment, the shape of nail-rod system and the degree of pain in the injured site were measured on the same X-ray machine (using VAS score method). The indexes of pre-operation, post-operation and follow-up were compared between the two groups, and the patients' lumbago and back pain and functional recovery were analyzed at the same time. Including: the height of the anterior and posterior edges of the injured vertebrae and the Cobb angle of the injured vertebrae at 4 days, 3 months, 6 months, 12 months and at the time of removal of the nail rod system (14-16 months after operation) in both groups, and the spinal Cobb angle of the injured vertebrae. The complete condition of the nail-rod system and the pain degree of the two groups were evaluated before operation and 6 months after the operation. Results: the results were as follows: 4 days and 3 months after operation, there was no significant difference in vertebral height (anterior edge and posterior edge) between groups (P0.05). The Cobb angle of injured vertebrae was statistically significant (P0.05), and the anterior height of injured vertebrae was statistically significant from 6 months to 6 months after operation (P0.05). 6 months after operation, there was no significant difference in the degree of injury pain between the two groups (P0.05), but there was a statistically significant difference in the degree of pain between the two groups when the nail-rod system was taken (P0.05). There was no significant difference in the posterior margin height of the injured vertebrae between the two groups. The fracture of the rod was found in two cases of the injured vertebrae group during the follow-up. Conclusion: the treatment of thoracolumbar fracture by transposition can recover the anterior height of vertebral body and correct the deformity of spine, reduce the loss of vertebral height and the failure of nail-rod system, and reduce the chronic pain of injured segment of the patient. The long-term effect is accurate. Compared with the traditional treatment of spindles, it has more advantages.
【学位授予单位】：贵阳中医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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