摘要
目的探讨后路减压植骨联合椎弓根螺钉内固定术治疗脊柱骨折的临床疗效。方法选择2020年1月至2022年7月于信阳市中心医院择期行手术治疗的150例脊柱骨折患者为研究对象,根据手术方法将患者分为对照组(n=50)和观察组(n=50)。对照组患者采用椎弓根螺钉内固定术,观察组患者采用后路减压植骨联合椎弓根螺钉内固定术。记录2组患者的手术时间、术中出血量、住院时间及伤口愈合时间。于术后1个月评估2组患者的临床疗效。分别于术前、术后1个月,采用美国脊髓损伤协会(ASIA)分级评估2组患者的脊髓神经功能,行X线、CT检测2组患者的伤椎修复指标Cobb角及伤椎前缘高度。观察并记录2组患者术后6个月内并发症发生情况,包括固定物断裂及松动、感染及胃肠道反应。结果观察组与对照组患者的手术时间比较差异无统计学意义(P>0.05);观察组患者的术中出血量显著少于对照组,住院时间及伤口愈合时间显著短于对照组(P<0.05)。对照组和观察组患者的总有效率分别为90.00%(45/50)、100.00%(50/50);观察组患者的总有效率显著高于对照组(χ^(2)=5.263,P<0.05)。术前,2组患者的ASIA分级分布情况比较差异无统计学意义(Hc=0.632,P>0.05);对照组和观察组患者术后1个月的ASIA分级分布情况较术前改善(Hc=22.538、45.637,P<0.05);术后1个月,观察组患者的ASIA分级分布情况优于对照组(Hc=17.589,P<0.05)。术前,2组患者的Cobb角、伤椎前缘高度比较差异无统计学意义(P>0.05);术后1个月,观察组患者的Cobb角显著小于对照组,伤椎前缘高度显著大于对照组(P<0.05);2组患者术后1个月的Cobb角显著小于术前、伤椎前缘高度显著大于术前(P<0.05)。观察组与对照组患者的并发症发生率比较差异无统计学意义(χ^(2)=1.099,P>0.05)。结论与椎弓根螺钉内固定术比较,后路减压植骨联合椎弓根螺钉内固定术治疗脊柱骨折可显著减少患者术中出血量,缩短住院时间和伤口愈合时间,更有效促进脊柱骨折患者椎体脊柱侧弯及生理高度的恢复,改善患者脊髓神经功能。
Objective To investigate the effect of posterior decompression and bone grafting combined with pedicle screw internal fixation in the treatment of spinal fractures.Methods A total of 150 patients with spinal fracture who underwent elective surgery at Xinyang Central Hospital from January 2020 to July 2022 were selected as the research subjects.According to the surgical method,the patients were divided into the control group(n=50)and the observation group(n=50).The patients in the control group underwent pedicle screw internal fixation,while the patients in the observation group underwent posterior decompression and bone grafting combined with pedicle screw internal fixation.The surgical time,intraoperative bleeding,hospitalization time and wound healing time of patients between the two groups were recorded.The clinical efficacy of patients in the two groups was evaluated at one month after surgery.Before and one month after surgery,the spinal cord nerve function of patients in the two groups was evaluated by the American spinal cord injury association(ASIA)grading.The Cobb angle and anterior edge height of the injured vertebral body of patients in the two groups were detected by X-ray and CT examinations.The occurrence of complications within 6 months after surgery of patients in the two groups was observed and recorded,including fixation breakage and loosening,infection and gastrointestinal reaction.Results There was no significant difference in surgical time of patients between the observation group and the control group(P>0.05);the intraoperative bleeding volume of patients in the observation group was significantly lower than that in the control group,and the hospital stay and wound healing time were significantly shorter than those in the control group(P<0.05).The total effective rate of patients in the control group and observation group was 90.00%(45/50)anD_(1)00.00%(50/50),respectively.The total effective rate of patients in the observation group was significantly higher than that in the control group(χ^(2)=5.236,P<0.05).There was no significant difference in the distribution of ASIA grading of patients between the two groups before surgery(Hc=0.632,P>0.05);the ASIA grading distribution of patients in the two groups at one month after surgery was better than that before surgery(Hc=22.538,45.637;P<0.05);one month after surgery,the ASIA grading distribution of patients in the observation group was better than that in the control group(Hc=17.589,P<0.05).Before surgery,there was no significant difference in Cobb angle and anterior edge height of patients between the two groups(P>0.05);one month after surgery,the Cobb angle of patients in the observation group was significantly smaller than that in the control group,and the anterior edge height of the injured vertebra was significantly higher than that in the control group(P<0.05);the Cobb angle of patients in the two groups at 1 month after surgery was significantly smaller than that before surgery,and the anterior edge height of the injured vertebra was significantly higher than that before surgery(P<0.05).There was no significant difference in the incidence of complications of patients between the observation group and the control group(χ^(2)=1.099,P>0.05).Conclusion Compared with pedicle screw internal fixation,posterior decompression and bone grafting combined with pedicle screw internal fixation can significantly reduce intraoperative bleeding of patients with spinal fractures,shorten hospital stay and wound healing time,more effectively promote the recovery of vertebral scoliosis and physiological height in patients with spinal fracture,and improve spinal cord nerve function.
作者
马向伟
薛栋
MA Xiangwei;XUE Dong(Department of Orthopedics,Xinyang Central Hospital,Xinyang 464000,Henan Province,China)
出处
《新乡医学院学报》
CAS
2023年第11期1051-1055,共5页
Journal of Xinxiang Medical University
关键词
后路减压植骨
椎弓根螺钉内固定术
脊柱骨折
脊髓神经
posterior decompression and bone grafting
pedicle screw internal fixation
spinal fracture
spinal nerve
