矢状曲度参考模棒在胸腰椎骨折手术中的临床应用

Clinical application of the reference model about sagittal curves for the thoracolumbar fracture

中文关键词:  胸腰椎  骨折  矢状曲度  模棒

英文关键词:Thoracolumbar vertebrae  Fracture  Sagittal plane curves  Reference model

中文摘要:

  【摘要】 目的：评价在胸腰椎爆裂骨折手术中应用矢状曲度参考模棒的临床意义。方法：312例正常人体行站立标准侧位X线摄片，通过Cobb法（测量相邻椎体上终板垂线夹角），得到胸腰椎相邻节段矢状曲度参考值并制作正常矢状曲度参考模棒。将126例胸椎、腰椎爆裂骨折患者分成对照组和观察组。两组患者均行后路钉棒系统内固定术，观察组连接棒的弧度按参考模棒进行预弯，对照组凭借医师经验行连接棒的预弯。记录两组手术时间、术中出血量、患者术前、术后即刻、末次随访的伤椎前缘压缩比、固定节段矢状曲度丧失角度及Frankel分级。结果：手术时间、术中出血量对照组分别为138.4±35.3min、276.7±40.7ml；观察组分别为105.3±38.9min、201.5±45.8ml，两组间有统计学差异（P<0.05）；术后即刻椎体前缘高度压缩比及固定节段矢状曲度丧失角度对照组分别为（80.5±2.7）%、8.3°±2.7°，观察组分别为（94.4±2.4）%、1.1°±0.7°，末次随访时对照组分别为（74.2±3.7）%、11.7°±3.3°，观察组分别为（93.7±2.5）%、1.2°±0.9°。术后即刻、末次随访时两个时间点对照组和观察组间有统计学差异（P<0.05）；在同组间比较，对照组末次随访与术后即刻有统计学差异（P<0.05），而观察组无统计学差异（P>0.05）。两组患者Frankel分级恢复情况比较，观察组优于对照组，差异有统计学意义（P<0.05）。结论：术中连接棒预弯弧度以矢状曲度模棒为参考可以更好地恢复胸腰椎骨折的椎体高度及矢状曲度，使患者术后获得更好的神经功能。

英文摘要:

  【Abstract】 Objective: To evaluate the surgical outcome of reference model about sagittal curves for the thoracolumbar burst fracture. Methods: 312 standing digital X-rays on normal adults were obtained, the sagittal angle by using Cobb method was measured(two vertical lines perpendicular to the lines parallel to the superior endplate of the above vertebra and the superior endplate of the below adjacent vertebral body), the normal reference value of sagittal curves about the thoracic and lumbar spine was developed and the reference model about sagittal plane curves was formed. 126 cases of patients with thoracolumbar burst fracture were divided into control group and observation group. All patients underwent posterior fixation and fusion． The reference model of sagittal curves was applied to restore sagittal curves in observation group, while in control group, the routine surgery was performed. The operation time and blood loss, the number of patients about the ratio of anterior vertebral compression, the sagittal loss angle, the Frankel grades before operation, immediately after operation and at final follow-up were recorded. Results: In control group, the operative time was 138.4±35.3min, intraoperative blood loss was 276.7±40.7ml; while in observer group, it was 105.3±38.9min and 201.5±45.8ml respectively, which showed significant difference between two groups(P<0．05). In postoperative control group, the compression ratio of vertebral anterior column was (80.5±2.7)%, the postoperative loss of sagittal angle was 8.3°±2.7°; in final follow-up the data were (74.2±3.7)%, 11.7°±3.3° respectively; while in observer group, the data were (94.4±2.4)%, 1.1°±0.7°, (93.7±2.5)%, 1.2°±0.9° respectively, Which showed significant difference(P<0.05) at each time points after operation between two groups; there were statistically significant difference at different time points after operation in control group(P<0.05), but no statistical difference in observer group(P>0.05). Between the two groups there were statistically different in recovery of Frankel grade(P<0.05), the recovery of observer group was better than control group. Conclusion: The instrument can restore better vertebral height and sagittal curvature of thoracolumbar spine, which also contribute a better neurologic recovery.