摘要
目的:分析Sextant经皮微创术内固定系统、后路手术及前路手术对脊柱骨折患者疗效的影响及术后再发骨折的危险因素。方法:选取医院收治的90例脊柱骨折患者,依据随机信封法将其分为微创组、后路组及前路组,每组30例。记录住院时间、手术时间、手术指标及术后再发骨折情况;治疗后3个月时评估临床疗效;术后即刻、术后1个月及术后3个月时对疼痛情况调查;术前及术后行影像学检查评估椎体矢状面指数、椎体前缘高度及Cobb角;术后3个月时采用生活质量评价简式-36(SF-36)量表对生存质量评估。结果:治疗后微创组患者临床疗效高于后路组及前路组,再发骨折率低于后路组及前路组,差异有统计学意义(x2=6.881,x2=7.485;P<0.05);手术时间高于后路组及前路组,切口长度、出血量及引流量低于后路组及前路组,差异有统计学意义(t手术时间=5.384,t=6.282;t切口长度=4.382,t=6.113;t出血量=5.192,t=6.891;t引流量=6.021,t=5.819;P<0.05);术后1个月及术后3个月时微创组患者疼痛评分低于后路组及前路组,差异有统计学意义(t1个月=6.394,t=6.255;t3个月=5.923,t=6.289;P<0.05);术后微创组患者椎体矢状面指数及椎体前缘高度高于后路组及前路组,Cobb角低于后路组及前路组,差异均有统计学意义(t矢状面指数=5.923,t=6.083;t前缘高度=4.958,t=5.881;tCobb角=5.038,t=5.681;P<0.05);术后微创组患者生理职能、情感智能、躯体疼痛、社会功能及总体健康生存质量评分均优于后路组及前路组,差异有统计学意义(t生理职能=6.321,t=5.771;t情感智能=5.848,t=5.786;t躯体疼痛=5.903,t=6.109;t社会功能=6.483,t=5.985;t总体健康=6.011,t=6.113;P<0.05);经多元线性回归分析,手术方式、Cobb角、椎体矢状面指数、椎体前缘高度、生活质量及术后疼痛是影响脊柱骨折患者术后再发骨折的独立性危险因素(t=4.064,t=3.500,t=2.747,t=2.831,t=2.457,t=2.566;P<0.05)。结论:Sextant经皮微创系统治疗脊柱骨折,可有效提高治疗疗效;手术方式、Cobb角、椎体矢状面指数、椎体前缘高度、生活质量及术后疼痛是影响脊柱骨折患者术后再发骨折的独立性危险因素。
Objective: To analyze the impacts of Sextant percutaneous minimally invasive internal fixation system, posterior approach operation, and anterior approach operation on the therapeutic effect of patients with spinal fracture, and analyze the risk factors of re-fracture of them. Methods: 90 patients with spinal fractures who admitted to our hospital were selected and were divided into group A(minimally invasive group), group B(posterior approach operation group) and group C(anterior approach operation) according to random envelope method, with 30 cases in each group. The hospitalization time, surgical time, surgical indicators, recurrence situation of fractures post operation were recorded. And the clinical efficacy was evaluated at the 3 th month after treatment. The pain situations at the immediate time-point after surgery, and at the 1 th month and the 3 th month post operation were investigated. And the imaging examination was implemented to assess the vertebral sagittal index, the anterior height of vertebral body and Cobb angle at pre and post operation. And the short form-36(SF-36) of life quality evaluation was adopted to assess survival quality of patients at the 3 th month post operation. Results: After treatment, the clinical efficacy of patients in group A was significantly higher than those in group B and C, and the incidence of postoperative recurrence of fractures of group A was significantly lower than that of group B and C, respectively,(x2=6.881, x2=7.485, P<0.05). And the time of operation of group A was significantly higher than group B and group C, while the incision length, bleeding volume and drainage volume of group A were significantly lower than those of groups B and C, respectively(tthe time of operation=5.384, t=6.282, tincision length=4.382, t=6.113, tbleeding volume=5.192, t=6.891, tdrainage volume=6.021, t=5.819, P<0.05). The scores of pain of group A was significantly lower than that of group B and group C at the 1 th month and the 3 th month after operation(tthe 1 th month=6.394, t=6.255, tthe 3 th month=5.923, t=6.289, P<0.05). The vertebral sagittal index, the anterior height of vertebral body of group A was significantly higher than group B and group C, while the Cobb angle of group A was significantly lower than group B and group C(tvertebral sagittal index=5.923, t=6.083, tanterior height of vertebral body=4.958, t=5.881, tCobb angle=5.038, t=5.681, P<0.05). The survey results indicated that the physical function, emotion intelligence, bodily pain, social function and the scores of overall health quality of life of group A were significantly better than those of group B and group C post operation(tphysical function=6.321, t=5.771, temotion intelligence=5.848, t=5.786, tbodily pain=5.903, t=6.109, tsocial function=6.483, t=5.985, ttotal health=6.011, t=6.113, P<0.05), respectively. The results of multiple linear regression indicated that surgical methods, Cobb angle, vertebral sagittal index and the anterior height of vertebral body, quality of life and postoperative pain were independent risk factors that affected recurrent fractures of patients with spinal fractures(t=4.064, t=3.500, t=2.747, t=2.831, t=2.457, t=2.566, P<0.05). Conclusions: The treatment of Sextant percutaneous minimally invasive system for spinal fractures can effectively improve therapeutic effect. And the surgical method, Cobb angle, vertebral sagittal index, anterior height of vertebral body, quality of life and postoperative pain are independent risk factor that affects recurrent fractures of patients with spinal fractures.
作者
王剑文
王京亮
皮安平
于宝新
郑泉鑫
WANG Jian-wen;WANG Jing-liang;PI An-ping(Department of Spine,Guangzhou Orthopedic Hospitai,Guangdong 510049,China)
出处
《中国医学装备》
2020年第8期104-108,共5页
China Medical Equipment
关键词
Sextant经皮微创术
后路手术
前路手术
脊柱骨折
术后再发骨折
Sextant percutaneous minimally invasive surgery
Posterior approach
Anterior approach
Spinal fracture
Postoperative fracture
作者简介
王剑文,男,(1975-),硕士,主治医师,从事脊柱外科方面的研究工作;通信作者:王京亮,nottobetrue@163.com。
