趙晨光 許文龍
【摘要】目的:探討脊柱胸腰段骨折應(yīng)用后路手術(shù)治療的效果及優(yōu)良率影響。方法:研究樣本都是我院的脊柱胸腰段骨折患者,病例是是100,就診起始年限是2019年1月,終止年限是2022年1月,按照隨機(jī)數(shù)字表法分為觀察組和對(duì)照組,一組50例行后路手術(shù)治療記作觀察組,一組50例更換為前路手術(shù)治療記作對(duì)照組,差異分析指標(biāo)是傷椎椎體前緣高度及椎體后凸Cobb角、手術(shù)優(yōu)良率。結(jié)果:術(shù)前兩組患者傷椎椎體前緣高度及椎體后凸Cobb角對(duì)比無(wú)明顯差異(P>0.05),術(shù)后7d觀察組傷椎椎體前緣高度為(22.54±4.26)mm明顯高于對(duì)照組,椎體后凸Cobb角為(6.02±1.07)°明顯小于對(duì)照組相應(yīng)指標(biāo)(P<0.05);觀察組患者的治療優(yōu)良率為94.00%,對(duì)照組治療優(yōu)良率為70.00%,觀察組患者的優(yōu)良率明顯高于對(duì)照組(P<0.05)。結(jié)論:對(duì)脊柱胸腰段骨折實(shí)施后路手術(shù)治療,可以提高椎體前緣高度和矢狀位參數(shù),降低傷椎楔變角,還可以促進(jìn)神經(jīng)功能的恢復(fù),提升手術(shù)優(yōu)良率。
【關(guān)鍵詞】脊柱胸腰段骨折;后路手術(shù)治療;效果;優(yōu)良率
A study on the effect and excellent and good rate of posterior surgery for thoracolumbar spine fractures
ZHAO Chenguang, XU Wenlong
Fuping Zhulaoda Bone Injury Hospital, Fuping, Shaanxi 711700, China
【Abstract】Objective: To investigate the effect of posterior surgery for thoracolumbar fractures of the spine and its influence on the excellent and good rate. Methods: The research samples were all patients with spinal thoracolumbar fractures in our hospital. The number of cases was 100. The starting year of treatment was January 2019, and the ending year was January 2022. According to the random number table method, they were divided into observation group and control group. A group of 50 patients who underwent posterior surgery was recorded as the observation group, and a group of 50 patients was replaced by anterior surgery as the control group. The difference analysis indicators were the height of the anterior edge of the injured vertebra, the Cobb angle of kyphosis, and the excellent and good rate of surgery. Results: There was no significant difference in the height of the anterior edge of the injured vertebral body and the Cobb angle of kyphosis between the two groups before operation (P>0.05). The height of the anterior edge of the injured vertebral body in the observation group was (22.54 ±4.26) mm, which was significantly higher than that in the control group 7 days after operation, and the Cobb angle of kyphosis was (6.02±1.07)°, which was significantly lower than that in the control group (P<0.05). The excellent and good rate was 94.00% in the observation group and 70.00% in the control group. The excellent and good rate in the observation group was significantly higher than that in the control group (P<0.05). Conclusion: Posterior surgical treatment of thoracolumbar fractures could improve the height of the anterior vertebral body and sagittal parameters, reduce the wedge angle of the injured vertebra, promote the recovery of nerve function, and improve the excellent and good rate of surgery.
【Key Words】Thoracolumbar fracture of spine; Posterior surgical treatment; Effect; Excellent and good rate
脊柱胸腰段骨折是脊椎骨折類型中發(fā)生頻率較高的一種,就國(guó)內(nèi)每年約有600~700萬(wàn)該病患者,男性神經(jīng)損傷比例較重,不同年齡段的損傷原因亦存在差異,主要致病原因往往有高處墜落或暴力撞擊腰椎,進(jìn)而導(dǎo)致椎體前柱或中柱被損傷[1-2]。在老年患者中較容易出現(xiàn)的是壓縮性骨折,該病起因于骨質(zhì)疏松與外傷的共同作用,壓縮性骨折患者的脊柱穩(wěn)定性極差,有時(shí)會(huì)壓迫脊髓神經(jīng),若不及時(shí)進(jìn)行有效的治療將影響患者的正常生活。手術(shù)治療是應(yīng)對(duì)該病的主要方案,有研究認(rèn)為[3-4],后路手術(shù)的優(yōu)勢(shì)在于能受損脊髓神經(jīng)最大限度地得以修復(fù),脊柱穩(wěn)定性盡可能的恢復(fù)到以前的狀態(tài),并減少并發(fā)癥的出現(xiàn),讓患者經(jīng)手術(shù)較快康復(fù)。為明確脊柱胸腰段骨折患者治療的有效措施,本研究以我院的脊柱胸腰段骨折患者為研究主體,旨在分析脊柱胸腰段骨折應(yīng)用后路手術(shù)治療的效果及優(yōu)良率影響。
1.1 一般資料
研究樣本都是我院的脊柱胸腰段骨折患者,病例是100,就診起始年限是2019年1月,終止年限是2022年1月,按照隨機(jī)數(shù)字表法分為觀察組和對(duì)照組,各50例,納入標(biāo)準(zhǔn):①經(jīng)X線片檢查確診單節(jié)段骨折;②符合手術(shù)指征;③年齡18~65歲且具有良好耐受性;④對(duì)本研究知情同意。排除標(biāo)準(zhǔn):①存在凝血功能障礙者;②器質(zhì)性病變及心腦血管病變;③骨質(zhì)疏松性骨折;④沒(méi)有堅(jiān)持全稱參與本研究者。兩組患者一般資料的差異分析結(jié)果,P>0.05,可對(duì)比,見(jiàn)表1。
1.2 方法
對(duì)照組實(shí)施的治療方式是前路手術(shù)治療,觀察組更換為后路手術(shù)治療,具體方法:①確認(rèn)穿刺進(jìn)針點(diǎn),借助C型臂X線機(jī)透視輔助明確手術(shù)椎體雙側(cè)椎弓根體表投影偏外1.5 cm為穿刺進(jìn)針點(diǎn)并做出相應(yīng)的標(biāo)記,對(duì)常規(guī)手術(shù)區(qū)域進(jìn)行消毒,并鋪設(shè)無(wú)菌毛巾,之后在之前標(biāo)記位置用穿刺針進(jìn)行穿刺,位置是椎體前中1/3處,并插入導(dǎo)針,在透視觀察后確保導(dǎo)針位置良好,依次順導(dǎo)針擴(kuò)大開(kāi)口、攻絲,選擇合適大小的椎弓根螺釘置入其中,保證透視螺釘位置無(wú)誤后從從頭端切口處穿入欽棒,置入兩根欽棒將之前置入的椎弓根螺釘連接起來(lái),透視見(jiàn)復(fù)位良好后,切口沖洗、止血、縫合。②采用在局部浸潤(rùn)麻醉下,G臂透視定位引導(dǎo)下對(duì)患者腰椎進(jìn)行手術(shù),電極暴露直徑為1cm,根據(jù)腰椎患者實(shí)際情況選用合適的手術(shù)模式及手術(shù)時(shí)間。
1.3 評(píng)價(jià)指標(biāo)及標(biāo)準(zhǔn)
(1)分別于術(shù)前及術(shù)后7d兩個(gè)時(shí)間點(diǎn)測(cè)量?jī)山M患者傷椎椎體前緣高度及椎體后凸Cobb角,方式是影像學(xué)檢查;(2)對(duì)比兩組患者手術(shù)效果,包括優(yōu)、良、差,優(yōu)良率=(優(yōu)+良)例數(shù)/總例數(shù)×100%。
1.4 統(tǒng)計(jì)學(xué)方法
采用SPSS 20.0統(tǒng)計(jì)學(xué)軟件進(jìn)行數(shù)據(jù)分析。計(jì)數(shù)資料采用(%)表示,進(jìn)行χ2檢驗(yàn),計(jì)量資料采用(χ±s) 表示,進(jìn)行t檢驗(yàn),P<0.05為差異具有統(tǒng)計(jì)學(xué)意義。
2.1 兩組患者傷椎椎體前緣高度及椎體后凸Cobb角對(duì)比
從傷椎椎體前緣高度及椎體后凸Cobb角觀察得出,術(shù)前組間差別沒(méi)有統(tǒng)計(jì)學(xué)價(jià)值(P>0.05),術(shù)后7d觀察組傷椎椎體前緣高度為(22.54±4.26)mm明顯高于對(duì)照組,椎體后凸Cobb角為(6.02±1.07)°明顯小于對(duì)照組相應(yīng)指標(biāo),差異均具有統(tǒng)計(jì)學(xué)意義(P<0.05),見(jiàn)表2。
2.2 兩組患者手術(shù)優(yōu)良率對(duì)比
觀察組患者的治療優(yōu)良率為94.00%,對(duì)照組治療優(yōu)良率為70.00%,觀察組患者的優(yōu)良率明顯高于對(duì)照組,差異具有統(tǒng)計(jì)學(xué)意義(P<0.05),見(jiàn)表3。
脊柱胸腰段骨折由于該節(jié)段突然缺少肋骨的支撐,故而擴(kuò)大脊椎屈伸的活動(dòng)范圍,常因高處墜落或暴力撞擊胸腰椎致傷[5]。脊柱胸腰段骨折是多神經(jīng)功能損傷的一種,患者往往存在劇烈的疼痛感,有時(shí)候感到呼吸困難、腹痛,甚至出現(xiàn)障礙等,生命健康受到嚴(yán)重的干擾[6]。對(duì)脊柱胸腰段骨折患者行手術(shù)治療,患者癥狀得到明顯的改善,能較早實(shí)現(xiàn)下床活動(dòng),但其操作的有創(chuàng)傷性有所會(huì)對(duì)患者的神經(jīng)造成損傷[7]。手術(shù)是脊柱胸腰段骨折主要的治療方式,且提倡及時(shí)手術(shù),但是有必要選擇效果較優(yōu)的手術(shù)方式[8-9]。
本研究結(jié)果顯示,從傷椎椎體前緣高度及椎體后凸Cobb角觀察得出,術(shù)前組間差別沒(méi)有統(tǒng)計(jì)學(xué)價(jià)值(P>0.05),術(shù)后7d觀察組傷椎椎體前緣高度為(22.54±4.26)mm明顯高于對(duì)照組,椎體后凸Cobb角為(6.02±1.07)°和對(duì)照組相比較低(P<0.05),由此提示后路對(duì)恢復(fù)患者椎體高度,維持脊柱穩(wěn)定具有重要作用。就優(yōu)良率分析發(fā)現(xiàn),觀察組高,對(duì)照組低(P<0.05),由此進(jìn)一步說(shuō)明,后路手術(shù)治療應(yīng)用于脊柱胸腰段骨折患者的效果顯著。
綜上所述,對(duì)脊柱胸腰段骨折實(shí)施后路手術(shù)治療,可以提高椎體前緣高度和矢狀位參數(shù),降低傷椎楔變角,還可以促進(jìn)神經(jīng)功能的恢復(fù),提升手術(shù)優(yōu)良率。
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