| 刘一丁,张沁昕,刘昊,杨物鹏.快速康复外科理念下不同后路内固定术治疗胸腰椎骨折的疗效对比[J].脊柱外科杂志,2024,22(2):105-110. |
快速康复外科理念下不同后路内固定术治疗胸腰椎骨折的疗效对比  点此下载全文 (Fulltext) |
| 刘一丁1 张沁昕2 刘昊2 杨物鹏2* |
1. 内蒙古科技大学包头医学院, 包头 014040;
2. 鄂尔多斯市中心医院脊柱外科, 鄂尔多斯 017000 |
| 基金项目：2020年内蒙古医科大学“科技百万工程”项目［YKD2020KJBW（LH）061］ |
| DOI：10.3969/j.issn.1672-2957.2024.02.006 |
| 摘要点击次数: 45 |
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| 摘要： |
| 目的 快速康复外科（ERAS）理念下比较3种后路内固定术（传统后路、经皮微创入路、Wiltse入路）治疗胸腰椎骨折的疗效。 方法 选择鄂尔多斯市中心医院2020年4月—2022年10月收治的90例胸腰椎骨折患者，采用随机数字表法分为3组：A组30例采用传统后路内固定术治疗，B组30例采用经皮微创内固定术治疗，C组30例采用Wiltse入路内固定术治疗。记录患者一般资料、手术基本情况，以及手术前后肌酸激酶（CK）水平、肌红蛋白（Mb）水平、多裂肌脂肪浸润程度（FIR）、伤椎Cobb角和疼痛视觉模拟量表（VAS）评分。 结果 所有手术顺利完成，所有患者随访时间＞ 6个月。A组手术时间长于B、C组，术中出血量A组＞ B组＞ C组，术中X线透视次数B组高于A、C组，差异均有统计学意义（P ＜ 0.05）。术后20 h CK、Mb水平A组高于B、C组，差异有统计学意义（P ＜ 0.05）；术后6个月多裂肌FIR A组＞ B组＞ C组，差异有统计学意义（P ＜ 0.05）。术后1 d、6个月伤椎Cobb角B组大于A、C组，差异有统计学意义（P ＜ 0.05）；所有患者术后VAS评分显著改善，且随着随访时间延长进一步改善，术后1 d、7 d VAS评分A组高于B、C组，差异均有统计学意义（P ＜ 0.05）。 结论 Wiltse入路内固定术损伤小，更符合ERAS理念。 |
| 关键词：胸椎|腰椎|脊柱骨折|骨折固定术，内|快速康复外科 |
| Comparison of therapeutic effects of different posterior internal fixation for thoracolumbar fractures based on enhanced recovery after surgery concept Fulltext |
| Liu Yiding Zhang Qinxin Liu Hao Yang Wupeng |
1. Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou 014040, Inner Mongolia Autonomous Region, China;
2. Department of Spinal Surgery, Ordos Central Hospital, Ordos 017000, Inner Mongolia Autonomous Region, China |
| Fund Project: |
| Abstract: |
| Objective To compare the efficacy of 3 types of posterior internal fixation surgery（traditional posterior approach，percutaneous minimally invasive approach，and Wiltse approach） for the treatment of thoracolumbar fractures under the concept of enhanced recovery after surgery（ERAS）. Methods From April 2020 to October 2022，90 patients with thoracolumbar fractures admitted to Ordos Central Hospital were randomly divided into 3 groups using a random number table method：group A，30 patients received traditional posterior internal fixation；group B，30 patients received percutaneous minimally invasive internal fixation；and group C 30 patients received Wiltse approach internal fixation. The general information，basic surgical conditions，as well as the levels of creatine kinase（CK） and myoglobin（Mb），the fat infiltration ratio（FIR） in the multifidus muscle，the Cobb angle of the injured vertebra，and the pain visual analogue scale（VAS） score at pre- and post-operation were recorded. Results All the surgeries were successfully completed，and all the patients were followed up for more than 6 months. The operation time in group A was longer than that in groups B and C，and the intraoperative blood loss was group A＞group B＞group C，and the intraoperative fluoroscopy frequency in group B was higher than those in groups A and C，and the differences were statistically significant（P ＜ 0.05）. At postoperative 20 h，the levels of CK and Mb in group A were higher than those in groups B and C，with a statistically significant difference（P ＜ 0.05）. At postoperative 6 months，multifidus muscle FIR was group A＞ group B＞group C，with a statistically significant difference（P ＜ 0.05）. At postoperative 1 d and 6 months，the Cobb angle of the injured vertebrae in group B was greater than that in groups A and C，with a statistically significant difference（P ＜ 0.05）. All the patients showed significant improvement in postoperative VAS scores，and as the follow-up time was extended，further improvement resulted；at postoperative 1 d and 7 d，the VAS scores in group A were higher than those in groups B and C，with a statistically significant difference（P ＜ 0.05）. Conclusion The Wiltse approach internal fixation has less injury and is more in line with ERAS concept. |
| Keywords:Thoracic vertebrae|Lumbar vertebrae|Spinal fractures|Fracture fixation,internal|Enhanced recovery after surgery |
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