中国组织工程研究 ›› 2022, Vol. 26 ›› Issue (6): 919-923.doi: 10.12307/2022.177

• 脊柱植入物Spinal implants • 上一篇    下一篇

脊柱外固定弹性应力治疗跳跃性脊柱骨折

郭小惠1,宋西正2,向含睿2,康照荣1,李达明1,康  禹2,胡  军1,盛  凯2   

  1. 1重庆郭昌毕骨伤科医院,重庆市   408000;2南华大学附属第一医院,湖南省衡阳市   421000
  • 收稿日期:2021-02-01 修回日期:2021-02-05 接受日期:2021-06-17 出版日期:2022-02-28 发布日期:2021-12-07
  • 通讯作者: 宋西正,主任医师,博士,教授,硕士生导师,南华大学附属第一医院,湖南省衡阳市 421000
  • 作者简介:郭小惠,女,1964年生,汉族,重庆市人,副主任医师,主要从事中西结合脊柱微创方面的研究。
  • 基金资助:
    重庆市卫联合中医药科研项目(2019ZY013438),项目负责人:宋西正;湖南省自然基金面上项目(2019JJ40266),项目负责人:宋西正

External spinal fixation elastic stress in the treatment of jumping spinal fracture

Guo Xiaohui1, Song Xizheng2, Xiang Hanrui2, Kang Zhaorong1, Li Daming1, Kang Yu2, Hu Jun1, Sheng Kai2   

  1. 1Guochang Bi Orthopedics and Traumatology Hospital of Chongqing, Chongqing 408000, China; 2First Affiliated Hospital, University of South China, Hengyang 421000, Hunan Province, China
  • Received:2021-02-01 Revised:2021-02-05 Accepted:2021-06-17 Online:2022-02-28 Published:2021-12-07
  • Contact: Song Xizheng, Chief physician, MD, Professor, Master’s supervisor, First Affiliated Hospital, University of South China, Hengyang 421000, Hunan Province, China
  • About author:Guo Xiaohui, Associate chief physician, Guochang Bi Orthopedics and Traumatology Hospital of Chongqing, Chongqing 408000, China
  • Supported by:
    Chongqing Municipal Health United Traditional Chinese Medicine Research Project, No. 2019ZY013438 (to SXZ); Hunan Provincial Natural Science Foundation of China, No. 2019JJ40266 (to SXZ)

摘要:

文题释义:
脊柱外固定弹性应力:脊柱的外固定装置由经皮椎弓根螺钉和体外连接纵形长棒组成,在固定后轻微弯曲,患者在活动中自然产生一种微量的弹性活动,即弹性应力。这种弹性应力对骨折椎体的骨折面产生微量有效的弹性生物应力刺激,促进骨痂形成,促进骨折愈合。
跳跃性脊柱骨折:骨折椎体间隔2个或2个以上正常椎体的脊柱骨折,即多节段非相邻型脊柱骨折,临床上比较常见,发生部位主要在胸、腰椎,其损伤严重、并发伤多,临床治疗复杂且易出现并发症。


背景:目前国内外通常采用非融合性内固定治疗跳跃性脊柱骨折,易出现相邻椎间盘严重退变、断钉、断棒、脊柱僵硬恢复困难等相关并发症,尤其是无法避免第二次内固定取出手术,造成组织再次损伤。
目的:分析脊柱外固定弹性应力治疗跳跃性脊柱骨折治疗的临床疗效。
方法:选择2016年7月至2019年7月南华大学附属第一医院及重庆郭昌毕骨伤科医院收治的跳跃性脊柱骨折患者65例,其中男37例,女28例,年龄20-55岁,按照治疗方式分2组,对照组(n=32)进行椎弓根螺钉置入内固定治疗,试验组(n=33)进行脊柱外固定弹性应力治疗。比较两组患者手术前后的伤椎前缘高度丢失率、Oswestry功能障碍指数、目测类比评分及骨痂形成状况。研究获得南华大学附属第一医院及重庆郭昌毕骨伤科医院伦理委员会批准。
结果与结论:①两组患者术后的伤椎前缘高度丢失率均低于术前(P < 0.05),试验组术后1周、3个月的伤椎前缘高度丢失率低于对照组(P < 0.05);②两组患者术后的Oswestry功能障碍指数、目测类比评分均低于术前(P < 0.05),试验组术后1周、3个月的Oswestry功能障碍指数及目测类比评分低于对照组(P < 0.05);③试验组患者术后3,12个月的骨痂形成率高于对照组(P < 0.05);④结果表明,脊柱外固定弹性应力治疗跳跃性脊柱骨折较传统椎弓根螺钉具有更好的效果。

https://orcid.org/0000-0003-4579-9306 (郭小惠)

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

关键词: 跳跃性脊柱骨折, 脊柱外固定, 椎弓根螺钉, 钉棒固定, 弹性应力, 临床疗效, 非融合性, 刚性应力

Abstract: BACKGROUND: At present, non-fusion internal fixation is usually used in the treatment of jumping spinal fracture which is prone to severe degeneration of adjacent intervertebral discs, broken nails, broken rods, and difficulties in spine stiffness and recovery. In particular, it is impossible to avoid the second internal fixation removal operation, resulting in re-injury of the tissue.  
OBJECTIVE: To analyze the clinical effect of external fixation of spinal elastic stress in the treatment of jumping spinal fracture.
METHODS:  Sixty-five patients with jumping spinal fracture from First Affiliated Hospital of University of South China and Guochang Bi Orthopedics and Traumatology Hospital of Chongqing from July 2016 to July 2019 were selected, including 37 males and 28 females, aged 20-55 years old. They were divided into two groups according to the treatment methods. The control group (n=32) received pedicle screw insertion and internal fixation, and the trial group (n=33) received external fixation and elastic stress treatment. The anterior edge high loss rate, Oswestry dysfunction index, visual analogue scale score, and callus formation were compared between the two groups before and after surgery. This study was approved by the Ethics Committee of First Affiliated Hospital of University of South China and Guochang Bi Orthopedics and Traumatology Hospital of Chongqing.  
RESULTS AND CONCLUSION: (1) The high loss rate of anterior edge of injured vertebra after surgery was lower than that before surgery in both groups (P < 0.05). The high loss rate of the anterior edge of the injured vertebra was lower in the trial group than that in the control group at 1 week and 3 months after operation (P < 0.05). (2) Postoperative Oswestry disability index and visual analogue scale score in both groups were lower than those before surgery (P < 0.05). Oswestry disability index and visual analogue scale score were lower in the trial group than those in the control group at 1 week and 3 months after surgery (P < 0.05). (3) The callus formation rate in the trial group was higher than that in the control group at 3 and 12 months after surgery (P < 0.05). (4) The results showed that the external fixation of the spine with elastic stress was more effective than that of the traditional pedicle screw in the treatment of jumping spinal fractures.

Key words: jumping spinal fracture, external spinal fixation, pedicle screws, fixed nail stick, elastic stress, clinical efficacy, non-fusion, rigid stress

中图分类号: