高海拔地区应用伤椎置钉技术治疗脊柱爆裂骨折

目的:针对高海拔地区脊柱爆裂骨折的特点及当地医疗条件,探讨椎弓根螺钉短节段固定联合伤椎置钉技术治疗胸腰椎爆裂骨折的临床疗效。方法:自2018年8月至2021年12月,采用伤椎置钉技术治疗12例无神经症状的单椎体胸腰椎爆裂骨折患者,其中男7例,女5例;年龄29~54(42.50±7.95)岁;车祸伤6例,高坠伤4例,重物砸伤2例;T₁₁2例,T₁₂4例,L₁3例,L₂2例,L₃1例。手术首先在骨折上下椎置钉,并在伤椎置入椎弓根螺钉,安装连接棒,通过体位及撑开实现骨折椎体复位。应用视觉模拟评分(visual analogue scale,VAS)及日本骨科协会(Japanese Orthopaedic Association,JOA)评分评估患者疼痛及生活质量改变情况,通过X线测量受伤节段后凸矫正率及矫正丢失率。结果:所有患者手术顺利,术中无明显并发症,12例患者均获随访,时间9~27(17.75±5.79)个月。术后3 d,VAS与术前入院时相比差异有统计学意义(t=6.701,P=0.000);术后9个月JOA评分与术前入院时相比差异有统计学意义(t=5.085,P=0.000)。术后3 d,Cobb角为(4.42±1.16) °,与术前入院时的(25.67±5.71) °相比矫正率为(82±5)%;术后9个月Cobb角(5.08±1.24) °,矫正丢失率为(16±13)%。无内固定松动及断裂。结论:高原低气压低氧环境下,应保证手术效果的同时减少创伤,应用伤椎置钉技术能够有效恢复并维持伤椎高度,出血少,固定节段短,是治疗高海拔地区脊柱爆裂骨折的有效方法。

Treatment of spinal burst fractures with pedicle screw fixation at high altitude area

Objective According to the characteristics of spinal burst fractures in high-altitude areas and the local medical conditions,to explore the clinical efficacy of short-segment fixation with pedicle screws combined with screw placement in injured vertebrae in the treatment of thoracolumbar burst fractures.Methods From August 2018 to December 2021,12 patients with single-vertebral thoracolumbar burst fractures without neurological symptoms were treated with injured vertebral screw placement technique,including 7 males and 5 females;aged 29 to 54 years old,with an average of(42.50±7.95) years old;6 cases of traffic accident injury,4 cases of high fall injury,2 cases of heavy object injury;2 cases of T₁₁,4 cases of T₁₂,3 cases of L₁,2 cases of L₂,and 1 case of L₃. In the operation,screws were first placed in the upper and lower vertebrae of the fracture,pedicle screws were placed in the injured vertebra,and connecting rods were installed,and the fractured vertebral body was reset by positioning and distraction. Visual analogue scale (VAS) and Japanese Orthopedic Association (JOA) scoring were used to evaluate the changes in pain and quality of life of patients,and the kyphotic correction rate and correction loss rate of the injured segment were measured by X-ray.Results All operations were successful without significant intraoperative complications. All 12 patients were followed up,the duration ranged from 9 to 27 months,with an mean of (17.75±5.79) months. VAS at 3 days after operation was significantly higher than that at admission (t=6.701,P=0.000). There was significant difference in JOA score between 9 months after operation and at admission (t=5.085,P=0.000). Three days after operation,Cobb angle was (4.42±1.16)°,and the correction rate was (82±5)% compared with (25.67±5.71)° at admission. Cobb angle was (5.08±1.24) åt 9 months after operation,with a corrected loss rate of (16±13)%. No loosening or breakage of internal fixation was found.Conclusion Under the high-altitude hypobaric and hypoxic environment,the effect of the operation should be ensured while reducing the trauma. The application of the technique of placing screws on the injured vertebra can effectively restore and maintain the height of the injured vertebra,with less bleeding and shorter fixed segments,which is an effective method.