胸腰段A型骨折术后支具佩戴时间对疗效的影响

Effect of bracing post-operatively on the patients with type A thoracolumbar fracture

中文关键词:  胸腰段骨折  支具  佩戴时间

英文关键词:Thoracolumbar fracture  Orthosis  Time of bracing

中文摘要:

  【摘要】 目的：探讨胸腰段A型骨折术后支具佩戴时间对疗效的影响。方法：2008年1月~2012年12月收治并获得随访的单节段胸腰段（T11~L2）A型骨折患者66例，均采用单纯Schanz螺钉固定的术式，术后第2天开始佩戴胸腰支具。根据术后支具佩戴时间分为A组和B组：A组患者32例，支具佩戴时间＜1个月；B组34例，佩戴支具时间＞1个月且＜3个月。术前伤椎后凸Cobb角A组为22.1°±4.9°，B组为21.9°±5.4°；术前椎体压缩率A组为（31.8±6.8）%，B组为（32.6±6.5）%。两组患者的年龄、性别、骨折节段、术前后凸Cobb角和术前椎体压缩率均无统计学差异（P≥0.05）。测量术后及术后1年时的伤椎后凸Cobb角，计算术后1年时的后凸Cobb角丢失率。术后1年时进行腰痛的视觉模拟疼痛评分（VAS）、JOA评分、Oswestry功能障碍指数（Oswestry disability index，ODI）及总体生活质量评分。结果：两组术后均未出现并发症。术后伤椎后凸Cobb角A组为7.2°±2.9°，B组为7.2°±2.9°；术后1年Cobb角A组为8.1°±2.8°，B组为8.4°±3.2°；Cobb角丢失率A组为（14.4±20.2）%，B组为（19.6±23.5）%；两组比较均无统计学差异（P≥0.05）。术后椎体压缩率A组为（15.3±3.7）%，B组为（15.8±3.9）%；术后1年椎体压缩率A组为（16.8±4.0）%，B组为（17.1±3.8）%；两组比较均无统计学差异（P≥0.05）。术后1年VAS评分A组为1.03±0.56分，B组为1.18±0.68分；术后1年ODI A组为（9.9±3.3）%，B组为（11.3±3.4）%；两组比较均无统计学差异（P≥0.05）。术后1年患者生活质量评分A组为2.6±0.5分，B组为2.1±0.7分，两组比较有统计学差异（P＜0.05）。术后1年JOA评分A组为25.3±1.2分，B组为24.4±1.5分，两组比较有统计学差异（P＜0.05）。术后3个月随访A组患者骨性愈合29例（90.6%），B组31例（91.2%），两组骨性愈合率比较无统计学差异（P≥0.05）；术后1年随访两组患者均骨性愈合，且无内固定失败。结论：对于单节段胸腰段A型骨折患者，术后长时间（＞1个月）佩戴支具与较短时间（＜1个月）佩戴支具的临床疗效无明显差异，较短时间佩戴支具患者术后生活质量评分和JOA评分更高。

英文摘要:

  【Abstract】 Objectives: To discuss the effect of bracing time on the outcome in the post-operative patients who have type A thoracolumbar fracture. Methods: A retrospective analysis was performed on sixty-six patients with single-level type A thoracolumbar fracture from January 2008 to December 2012. Schanz pedicle screws were used in all patients and all of them wore thoracolumbosacral orthosis(TLSO) from 1 day after operation. These patients were divided into two groups according to time of bracing: 32 patients wearing TLSO for less than 1 month after operation were classified as group A, while the other 34 patients wearing TLSO for more than 1 month were classified as group B. The pre-operative Cobb angle was 22.1°±4.9° in group A and 21.9°±5.4° in group B, compression ratio of vertebrae before operation was (31.8±6.8)% in group A and (32.6±6.5)% in group B. There was no statistical difference with respect to the age, gender, fracture segment, pre-operative Cobb angle or pre-operative compression ratio of vertebrae(P≥0.05). The Cobb angles immediately after operation and at 1 year after operation were measured. One year after operation, all patients were asked to finish a series of evaluation, which included visual analogue scale(VAS), JOA score, Oswestry disability index(ODI) and general life quality. Results: No post-operative complications were noted in both groups. The Cobb angle immediately after operation was 7.2°±2.9° in both group A and group B. The Cobb angle at 1 year after operation was 8.1°±2.8° in group A and 8.4°±3.2° in group B, with the loss rate of Cobb angle of (14.4±20.2)% in group A and (19.6±23.5)% in group B. There was no statistical difference between 2 groups(P≥0.05). The compression ratio of vertebrae immediately after operation was (15.3±3.7)% in group A and (15.8%±3.9)% in group B. The compression ratio of vertebrae at 1 year after operation was (16.8±4.0)% in group A and (17.1%±3.8)% in group B. There was no statistical difference between group A and B(P≥0.05). The VAS score at 1 year after operation was 1.03±0.56 in group A and 1.18±0.68 in group B. The ODI at 1 year after operation was (9.9±3.3)% in group A and (11.3±3.4)% in group B. There was no statistical difference between group A and B(P≥0.05). The score of general life quality at 1 year after operation was 2.6±0.5 in group A and 2.1±0.7 in group B, and there was statistical difference between group A and B(P＜0.05). The JOA score at 1 year after operation was 25.3±1.2 in group A and 24.4±1.5 in group B, and there was statistical difference between group A and B(P＜0.05). The bony union was noted in 29 cases of group A(90.6%) and 31 cases in group B(91.2%) at 3 months after operation, there was no statistical difference between 2 groups(P≥0.05). All fractures healed at 1 year after operation and there was no instrument failure. Conclusions: For the post-operative patients with single segmental type A thoracolumbar fracture, long time(more than 1 month) and short time(less than 1 month) brace wearing show no difference on the outcome, but short time brace wearing has higher life quality score and JOA score.