Efficacy observation of trans-Kambin's triangle bone grafting of injured vertebrae combined with posterior internal fixation in treatment of patients with thoracolumbar burst fracture
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摘要:目的 观察经安全三角区伤椎植骨联合后路内固定治疗胸腰椎爆裂性骨折的效果。方法 回顾性分析2017年1月—2019年12月脊柱外科收治的41例胸腰椎爆裂性骨折患者的临床资料, 按术式的不同分为研究组20例(经安全三角区伤椎植骨联合后路内固定)和对照组21例(单纯后路内固定)。比较2组患者手术时间、术中出血量、住院时间、骨折愈合时间，以及术前及术后伤椎前缘高度比、伤椎Cobb角、视觉模拟评分法(VAS)评分、腰背部Oswestry功能障碍指数(ODI)评分和并发症等。结果 研究组手术时间长于对照组，骨折愈合时间短于对照组，差异有统计学意义(P < 0.05)。术后1周时，研究组伤椎前缘高度比大于对照组; 术后12个月及内固定取出后1个月时，研究组伤椎前缘高度比大于对照组, Cobb角小于对照组; 研究组伤椎前缘高度比和Cobb角的矫正度丢失均小于对照组，上述组间差异均有统计学意义(P < 0.05)。术后12个月及内固定取出后1个月时，研究组VAS评分、ODI评分均低于对照组，差异有统计学意义(P < 0.05)。2组患者术后切口均达到Ⅰ期愈合，随访期间未出现螺钉和连接棒断裂及其他并发症，末次随访时Frankel评级均为E级。结论 经安全三角区伤椎植骨联合后路内固定治疗胸腰椎爆裂性骨折效果显著，能维持伤椎前缘高度比和Cobb角，且安全性高，值得临床应用。Abstract:Objective To observe the effect of trans-Kambin's triangle bone grafting of injured vertebrae combined with posterior internal fixation in the treatment of patients with thoracolumbar burst fracture.Methods Clinical materials of 41 patients with thoracolumbar burst fractures in the Department of Spinal Surgery from January 2017 to December 2019 were analyzed retrospectively, and they were divided into study group (20 cases, treated with trans-Kambin's triangle bone grafting of injured vertebrae combined with posterior internal fixation) and control group (21 cases, only treated with posterior internal fixation) according to different operation methods. The operation time, intraoperative bleeding, hospital stay, fracture healing time, preoperative and postoperative height ratio of the anterior edge of the injured vertebra, Cobb angle of the injured vertebra, Visual Analogue Scale (VAS), Oswestry Dysfunction Index (ODI) of waist and back as well as complications were compared between the two groups.Results The operation time in the study group was significantly longer than that in the control group, while the fracture healing time was significantly shorter than that in the control group (P < 0.05). At 1 week after operation, the height ratio of the anterior edge of the injured vertebrae in the study group was greater than that in the control group; at 12 months after operation and 1 month after removal of internal fixation, the height ratios of the anterior edge of the injured vertebrae in the study group were greater than that in the control group, and the Cobb angle was smaller than that in the control group; the correct degree losses in the height ratio of the anterior edge of the injured vertebrae and the Cobb angle in the study group were smaller than those in the control group; the between-group differences mentioned above were statistically significant (P < 0.05). At 12 months after operation and 1 month after removal of internal fixation, the VAS scores and ODI scores of the study group were significantly lower than those of the control group (P < 0.05). The incision in both groups achieved primary healing after operation. During the follow-up, there were no fractures of screws and connecting rods and other complications, and all the patients scored grade E of Frankel rating at the last follow-up.Conclusion Trans-Kambin's triangle bone grafting of injured vertebrae combined with posterior internal fixation is effective in the treatment of patients with thoracolumbar burst fracture, which can maintain the height ratio of the anterior edge of the injured vertebra and Cobb angle with a high safety, so it is worthy of clinical application.
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表 1 2组患者一般资料比较[n(%)]
一般资料 研究组(n=20) 对照组(n=21) 年龄/岁 50.45±8.53 47.95±9.70 性别 男 11(55.00) 11(52.38) 女 9(45.00) 10(47.62) 病因 高处坠落 8(40.00) 7(33.33) 摔伤 4(20.00) 2(9.52) 交通伤 7(35.00) 11(52.38) 砸伤 1(5.00) 1(4.76) 骨折椎体部位 T11 2(10.00) 2(9.52) T12 4(20.00) 4(19.05) L1 9(45.00) 9(42.86) L2 5(25.00) 6(28.57) Frankel分级 C级 2(10.00) 2(9.52) D级 13(65.00) 12(57.14) E级 5(25.00) 7(33.33) 
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表 2 2组患者手术相关指标比较(x±s)
指标 研究组(n=20) 对照组(n=21) 手术时间/min 122.85±39.54* 84.14±34.30 术中出血量/mL 162.00±35.92 149.05±26.06 住院时间/d 12.51±3.55 12.01±4.27 骨折愈合时间/月 3.03±0.36* 3.61±0.50 与对照组比较, *P < 0.05。
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表 3 2组患者影像学指标比较(x±s)
时点/指标 伤椎前缘高度比/% Cobb角/° 研究组 对照组 研究组 对照组 术前 65.85±12.85 66.53±11.69 14.67±5.13 14.42±7.16 术后1周 96.58±2.91* 92.62±3.45 6.17±4.20 6.70±3.96 术后12个月 96.20±4.14* 91.91±4.91 7.75±4.70* 10.40±3.82 内固定取出后1个月 95.35±3.55* 90.44±4.35 8.69±5.14* 11.20±4.01 矫正度丢失 1.43±1.12* 2.35±1.44 2.13±1.17* 4.58±2.23 与对照组比较, *P < 0.05。
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表 4 2组患者手术前后VAS评分及ODI评分比较(x±s)
分 时点 VAS评分 ODI评分 研究组 对照组 研究组 对照组 术前 7.05±1.00 7.05±0.74 80.00±9.04 80.38±7.28 术后1周 3.45±0.61 3.67±0.66 44.70±5.52 46.48±6.35 术后12个月 1.16±0.38* 1.86±0.51 21.26±3.07* 25.47±4.89 内固定取出后1个月 0.64±0.35* 0.96±0.51 14.93±4.89* 18.56±3.28 VAS: 视觉模拟评分法; ODI: Oswestry功能障碍指数。与对照组比较, *P < 0.05。
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1. 李阳，张丽群，王艳梅，张文娟. 结构和心理授权联合模式在脑卒中老年病人中的应用效果分析. 实用老年医学. 2020(08): 852-855 . 
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