不同类型螺钉固定在胸腰椎压缩骨折后路短节段内固定手术中的临床疗效对比

Comparison of clinical outcomes of different screw types in posterior short-segment internal fixation for thoracolumbar compression fractures

中文关键词:  胸腰椎压缩骨折  手术  固定螺钉  万向螺钉  疗效

英文关键词:Thoracolumbar compression fracture  Surgery  Monoaxial screw  Polyaxial screw  Efficacy

中文摘要:

  【摘要】 目的：分析后路经伤椎置钉短节段内固定术治疗胸腰椎压缩骨折中伤椎应用固定螺钉与万向螺钉的疗效差异。方法：回顾性分析2015年6月~2023年10月因胸腰椎压缩骨折在我院接受后路复位短节段内固定术治疗的103例患者，其中男性59例，女性44例，年龄45.2±12.2岁（21~67岁）。伤椎上下相邻椎体均采用固定螺钉固定，伤椎采用固定螺钉或万向螺钉。所有患者均获得随访，随访时间为15.5±7.5个月（12~33个月）。记录患者手术时间、术中出血量，于术前、术后即刻和末次随访时的胸腰椎X线片上测量伤椎前缘高度、邻近上下椎体前缘高度、局部后凸Cobb角和伤椎楔形角。根据伤椎置钉类型分为固定螺钉组与万向螺钉组。两组间性别、年龄、AO分型及伤椎压缩程度无统计学差异（P＞0.05）。每组根据术前伤椎压缩程度分为3个亚组：A组，压缩小于30%；B组，压缩30%~50%；C组，压缩大于50%。记录各个亚组患者的伤椎塌陷高度比值、局部后凸Cobb角、伤椎楔形角，比较伤椎置入固定螺钉与万向螺钉对椎体骨折的复位效果及术后随访结果的差异。结果：最终固定螺钉组55例，万向螺钉组48例。固定螺钉组和万向螺钉组患者的住院时间、手术时间、腰痛VAS评分无统计学差异（P＞0.05）；万向螺钉组的术中出血量显著性小于固定螺钉组（P＜0.05）。亚组分析，A组伤椎固定螺钉23例，万向螺钉20例；B组伤椎固定螺钉17例，万向螺钉14例；C组伤椎固定螺钉15例，万向螺钉14例。A组伤椎固定螺钉固定和万向螺钉固定术后即刻的伤椎前缘高度、局部后凸Cobb角、伤椎楔形角的矫正值均无统计学差异（P＞0.05）；B组伤椎固定螺钉固定术后即刻的伤椎塌陷高度矫正效果显著好于万向螺钉固定（P＜0.001），末次随访时两组无显著性差异（P=0.664）；C组患者中，伤椎固定螺钉固定术后即刻及末次随访的伤椎塌陷高度矫正效果显著优于万向螺钉固定，有统计学差异（P＜0.05）。随访过程中，所有患者均未发生内固定松动或断裂。结论：胸腰椎压缩骨折当伤椎压缩程度超过50%时，伤椎置入固定螺钉术后即刻椎体复位效果及远期疗效均明显优于万向螺钉。

英文摘要:

  【Abstract】 Objectives: To compare the clinical efficacy of monoaxial versus polyaxial screws in posterior short-segment transpedicular internal fixation at the injured vertebra for thoracolumbar compression fractures.Methods: A retrospective analysis was conducted on 103 patients treated with posterior reduction and short-segment internal fixation for thoracolumbar compression fractures in our hospital between June 2015 and October 2023. There were 59 males and 44 females, with an average age of 45.2±12.2 years(21-67 years). The upper or lower vertebrae adjacent to the injured level were fixed with monoaxial screws, while the injured vertebrae were fixed with either monoaxial screws or polyaxial screws. All the patients were followed up for 15.5±7.5 months(12-33 months). Operative time and intraoperative blood loss were recorded, and radiographic parameters including anterior vertebral height of injured vertebrae and, adjacent upper and lower vertebrae, local kyphotic Cobb angle, wedge angle were measured preoperatively, immediately postoperatively, and at final follow-up on X-ray images. The patients were divided into a monoaxial screw group and a polyaxial screw group. There were no statistically significant differences in gender, age, AO classification and compression degree of the injured vertebrae between the two groups(P＞0.05). Each group was further stratified into 3 subgroups by compression degree: group A(<30%), group B(30%-50%), group C(>50%). The ratio of the collapsed height of the injured vertebrae, local kyphotic Cobb angle and vertebral wedge angle were recorded for each patient subgroup. The fracture reduction efficacy and differences in postoperative follow-up outcomes were compared between the monoaxial screw group and polyaxial screw group. Results: There were 55 cases in the monoaxial screw group and 48 cases in the polyaxial screw group. Hospital stay, operative time, and VAS scores of low back pain were comparable between the two groups(P>0.05), but polyaxial screw group had significantly less blood loss(P<0.05). For subgroup analysis, in group A, 23 cases were fixed with monoaxial screws, and 20 cases were fixed with polyaxial screws; In group B, 17 cases with monoaxial screws, 14 cases with polyaxial screws; In group C, 15 cases with monoaxial screws, 14 cases with polyaxial screws. In group A, the immediate postoperative anterior vertebral height of injured vertebrae, local kyphotic Cobb angle and vertebral wedge angle were not statistically different between monoaxial and polyaxial screw fixations(P>0.05). In group B, monoaxial screws showed significantly better immediate postoperative height correction(P<0.001), but no difference at final follow-up(P=0.664). In group C, monoaxial screws achieved significantly better height correction at immediate postoperation and final follow-up(P<0.05). No internal fixation loosening or breakage occurred in either group during follow-up. Conclusions: For thoracolumbar compression fractures with over 50% vertebral compression, monoaxial pedicle screws fixed at the fractured vertebra have significantly better immediate postoperative vertebral reduction effect and long-term efficacy than polyaxial screws.