中国组织工程研究

中国组织工程研究 ›› 2016, Vol. 20 ›› Issue (9): 1234-1241.doi: 10.3969/j.issn.2095-4344.2016.09.003

• 脊柱植入物 spinal implant • 上一篇    下一篇

比较不同方式置入椎弓根钉内固定修复胸腰椎爆裂骨折的生物相容性

侯 煜1，卜宏建1，杨 帆2，王林杰1，武士科1，李盼祥1，梁志兴1，孙 博1，申志坤1   

  1. 1河北大学附属医院骨科，河北省保定市   071000；2保定市第三中心医院骨科，河北省保定市   071000
  • 收稿日期:2015-12-24 出版日期:2016-02-19 发布日期:2016-02-19
  • 通讯作者: 王林杰，硕士，河北大学附属医院骨科，河北省保定市 071000
  • 作者简介:侯煜，男 1977年生，河北省保定市人，侗族，河北医科大学毕业，硕士，副主任医师，主要从事脊柱外科方面的研究。

Pedicle screw fixation with different approaches in treatment of thoracolumbar burst fracture: biocompatibility

Hou Yu1, Bu Hong-jian1, Yang Fan2, Wang Lin-jie1, Wu Shi-ke1, Li Pan-xiang1, Liang Zhi-xing1, Sun Bo1, Shen Zhi-kun1   

  1. 1Department of Orthopedics, the Affiliated Hospital of Hebei University, Baoding 071000, Hebei Province, China; 2Department of Orthopedics, the Third Central Hospital of Baoding City, Baoding 071000, Hebei Province, China
  • Received:2015-12-24 Online:2016-02-19 Published:2016-02-19
  • Contact: Wang Lin-jie, Master, Department of Orthopedics, the Affiliated Hospital of Hebei University, Baoding 071000, Hebei Province, China
  • About author:Hou Yu, Master, Associate chief physician, Department of Orthopedics, the Affiliated Hospital of Hebei University, Baoding 071000, Hebei Province, China

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被引次数

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摘要：

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文题释义：

后正中入路：胸腰段骨折的椎弓根螺钉内固定可以选择不同的修复入路。传统的治疗方式为腰椎后路正中切口，长15-20 cm，剥离两侧椎旁肌，部分或完全切除椎板，虽能达到充分减压坚强内固定的目的，但需要破坏腰椎后方韧带复合体、广泛剥离肌肉和长时间牵拉椎旁肌肉，容易导致术后顽固性腰背疼痛。
椎旁肌间隙入路：通过肌间隙入路进行胸腰段骨折椎弓根螺钉内固定，可以最大程度减少对棘间韧带等造成的损伤，椎旁肌的剥离也较少，因此可以有效降低术后各种远期并发症的发生率。

 

背景：临床对脊柱胸腰段骨折进行修复的过程中，椎弓根螺钉置入内固定是一种常用的修复方式。具体的内固定过程中，可以选择不同的修复入路方式。
目的：比较椎弓根螺钉经皮入路、后正中入路及椎旁肌间隙入路置入内固定修复脊柱胸腰段骨折的效果及生物相容性。
方法：纳入脊柱胸腰段骨折患者118例，均实施椎弓根螺钉置入内固定治疗，按照修复入路方式分为3组，后正中入路组38例，椎旁肌间隙入路组40例，经皮入路组40例。治疗后随访12个月，比较3组患者的围手术期情况、疼痛评分、椎体前缘高度、后凸角矫正效果、不良事件发生情况以及生物相容性。

结果与结论：①经皮入路组和椎旁肌间隙入路组的手术时间、术中出血量和术后卧床时间均显著短于或者少于后正中入路组，术后引流情况显著优于后正中入路组(P均<0.05)，但经皮入路组和椎旁肌间隙入路组除引流情况外，其余指标经比较差异均无显著性意义。②不同时刻对患者进行影像学检查，可得较之本组治疗前，术后即刻以及末次随访，3组的椎体前缘高度百分比以及后凸角均得到显著改善    (P均< 0.05)；但治疗前和术后即刻以及末次随访3组间进行比较，差异均无显著性意义。③治疗前3组患者的疼痛目测类比评分基本相当；但治疗后24 h，3 d、末次随访，经皮入路组和椎旁肌间隙入路组的的疼痛目测类比评分均显著低于后正中入路组(P均< 0.05)；经皮入路组和椎旁肌间隙入路组治疗后24 h，3 d、末次随访经比较差异均无显著性意义。④治疗后随访12个月，3组患者均未出现排斥反应或者伤口不愈合等。一部分患者虽然出现腰背痛现象，但程度较为轻微，且均经积极对症处理后疼痛程度得到显著的改善。⑤结果表明，对脊柱胸腰段骨折患者进行椎弓根螺钉置入内固定过程中，较之常规后正中入路，选择椎旁肌间隙入路和经皮入路均可获得满意的固定效果，且具有良好的生物相容性。 

ORCID: 0000-0001-8701-8323 (侯煜)

关键词: 骨科植入物, 脊柱植入物, 脊柱胸腰段骨折, 椎弓根螺钉系统, 修复入路, 椎旁肌间隙, 内固定, 生物相容性

Abstract:

BACKGROUND: During the repair of thoracolumbar fracture, pedicle screw fixation is a commonly used treatment method. In the process of fixation, the different approaches can be used. 
OBJECTIVE: To compare effect and biocompatibility of pedicle screw by percutaneous approach, posterior median approach, and intervertebral space approach for thoracolumbar fracture. 
METHODS: 118 cases of thoracolumbar fracture were included after pedicle screw fixation. All patients were divided into three groups according to the approach: posterior median approach group (38 cases), intervertebral space approach group (40 cases) and percutaneous approach group (40 cases). After 12 months of follow-up, perioperative conditions, pain score, vertebral height of anterior border, kyphosis correction effect, adverse events and biological compatibility were compared among three groups.
RESULTS AND CONCLUSION: (1) Operation time, intraoperative bleeding and time in bed after surgery were shorter or less in the percutaneous approach and intervertebral space approach groups than in the posterior median approach group. Postoperative drainage was better in percutaneous approach and intervertebral space approach groups than in the posterior median approach group (all P < 0.05). Except drainage in the percutaneous approach and intervertebral space approach groups, no significant difference in other indicators was found. (2) Patients received imaging examination at different time points. The percentage of anterior vertebral height and kyphosis were significantly improved immediately after treatment and in final follow-up (all P < 0.05). No significant difference was detected before treatment, immediately after treatment and in final follow-up. (3) Visual Analogue score was identical before treatment. Visual analogue score was lower in the percutaneous approach and intervertebral space approach groups than in the posterior median approach group at 24 hours and 3 days after treatment and in final follow-up (all P < 0.05). No significant difference was detectable at 24 hours and 3 days after treatment and in final follow-up between the percutaneous approach and intervertebral space approach groups. (4) No rejection or wound non-healing was seen at 12 months after treatment. Some patients suffered from mild low back pain, which was improved by active symptomatic treatment. (5) These findings suggest that intervertebral space approach percutaneous approach obtained satisfactory outcomes compared with posterior median approach for treatment of thoracolumbar spine fractures, and good biocompatibility was found.