| 韩松,李红卫,李宇卫,俞鹏飞.O形臂导航辅助经皮椎弓根螺钉内固定术结合术前两步复位法治疗胸腰椎骨折[J].脊柱外科杂志,2023,21(1):1-6. |
O形臂导航辅助经皮椎弓根螺钉内固定术结合术前两步复位法治疗胸腰椎骨折  点此下载全文 (Fulltext) |
| 韩松1 2 李红卫1 李宇卫1* 俞鹏飞1 |
1. 南京中医药大学附属苏州市中医医院骨伤科, 苏州 215007;
2. 南京中医药大学附属宿迁市中医院骨伤科, 宿迁 223800 |
| 基金项目：苏州市临床重点病种诊疗技术专项项目（LCZX202113） |
| DOI：10.3969/j.issn.1672-2957.2023.01.001 |
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| 摘要： |
| 目的 探讨O形臂导航辅助经皮椎弓根螺钉内固定术结合术前两步复位法治疗胸腰椎骨折的临床疗效。方法 2019年1月—2021年12月，南京中医药大学附属苏州市中医医院收治无神经症状的单椎体胸腰椎压缩性骨折患者92例，采用随机数字表法分为2组，一组采用O形臂导航辅助经皮椎弓根螺钉内固定术结合术前两步复位法治疗（联合组，n=46），另一组采用单纯O形臂导航辅助经皮椎弓根螺钉内固定术治疗（对照组，n=46）。记录2组手术时间，手术前后各时间点伤椎压缩率及后凸角。术后48 h在CT三维重建图像上观察椎弓根螺钉位置，并计算优良率。结果 所有治疗顺利完成，患者随访> 3个月。所有患者术后伤椎压缩率随时间推移有一定程度增加，但术后各时间点伤椎压缩率较术前降低，且联合组术后各时间点伤椎压缩率低于对照组，差异均有统计学意义（P < 0.05）。2组患者根据术前伤椎压缩率分为2个亚组（30%≤术前伤椎压缩率< 50%亚组和术前伤椎压缩率≥50%亚组），术后12周联合组各亚组伤椎压缩率低于对照组，差异均有统计学意义（P < 0.05）。所有患者置钉前及术后各时间点伤椎后凸角较术前降低，且联合组置钉前及术后各时间点伤椎后凸角小于对照组，差异均有统计学意义（P < 0.05）。联合组置钉优良率明显高于对照组，差异有统计学意义（P < 0.05）。结论 O形臂导航辅助经皮椎弓根螺钉内固定术结合术前两步复位法治疗胸腰椎骨折可明显提高螺钉置入精准度，减少后期伤椎高度丢失，减小残存伤椎后凸角。 |
| 关键词：胸椎 腰椎 骨折,压缩性 手法,骨科 内固定器 外科手术,微创 |
| O-arm navigation assisted percutaneous pedicle screw internal fixation combined with preoperative two-step reduction for thoracolumbar fractures Fulltext |
| Han Song1 2 Li Hongwei1 Li Yuwei1* Yu Pengfei1 |
1. Department of Orthopaedics and Traumatology, Suzhou Hospital of Traditional Chinese Medicine, Nanjing University of Traditional Chinese Medicine, Suzhou 215007, Jiangsu, China;
2. Department of Orthopaedics and Traumatology, Suqian Hospital of Traditional Chinese Medicine, Nanjing University of Traditional Chinese Medicine, Suqian 223800, Jiangsu, China |
| Fund Project: |
| Abstract: |
| Objective To investigate the clinical effect of O-arm navigation assisted percutaneous pedicle screw internal fixation combined with preoperative two-step reduction in the treatment of thoracolumbar fractures. Methods From January 2019 to December 2021, Suzhou Hospital of Traditional Chinese Medicine affiliated to Nanjing University of Traditional Chinese Medicine treated 92 patients with single-segment thoracolumbar compression fracture without neurological symptoms, who were divided into 2 groups by random number table method. One group was treated with O-arm navigation assisted percutaneous pedicle screw internal fixation combined with preoperative two-step reduction(combined group, n=46), and the other group only with O-arm navigation assisted percutaneous pedicle screw internal fixation(control group, n=46). The operation time, vertebral compression rate and kyphosis angle of injured vertebra were recorded before and after operation. At postoperative 48 h, the pedicle screw position was observed on three-dimensional CT reconstruction images, and its excellent and good rate was calculated. Results All the treatments were successfully completed, and all the patients were followed up for more than 3 months. The compression rate of injured vertebrae in all the patients increased after surgery over time, but the compression rate of injured vertebrae at each time point after surgery was lower than that before surgery, and the compression rate of injured vertebrae at each time point after surgery in the combined group was lower than that in the control group, and the differences were statistically significant(P < 0.05). The patients in the 2 groups were divided into 2 subgroups according to the preoperative compression rate of injured vertebrae(30% ≤ preoperative compression rate of injured vertebrae < 50% subgroup and preoperative compression rate of injured vertebrae ≥ 50% subgroup);at postoperative 12 weeks, the compression rate of injured vertebrae of each subgroup in the combined group was lower than that in the control group, and the differences were statistically significant(P < 0.05). The kyphosis angles of injured vertebrae in all the patients before screw placement and each time point after surgery were lower than those before surgery, and the kyphosis angles of injured vertebrae before screw placement and each time point after surgery in the combined group were lower than those in the control group, all with a statistically significant difference(P < 0.05). The excellent and good rate of screw position in the combined group was significantly higher than that in the control group, and the difference was statistically significant(P < 0.05). Conclusion O-arm navigation assisted percutaneous pedicle screw internal fixation combined with preoperative two-step reduction for thoracolumbar fractures can significantly improve the accuracy of screw placement, reduce the height loss of injured vertebrae in the later stage, and reduce the kyphosis angle of residual injured vertebrae. |
| Keywords:Thoracic vertebrae Lumbar vertebrae Fractures,compression Manipulation,orthopedic Internal fixators Surgical procedure,minimally invasive |
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