Ji Piyao, Jiang Huanyu, Zhou Yan, Ming Jianghua, Chen Qing, Deng Ming, Li Yaming, Ma Yonggang, Liu Shiqing
Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan Hubei, 430060, P. R. China.
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Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Oct 15;37(10):1246-1252. doi: 10.7507/1002-1892.202306020.
To investigate the effectiveness of sagittal top compression reduction technique in the treatment of thoracolumbar vertebral fractures.
A retrospective analysis was conducted on the clinical data of 59 patients with thoracolumbar vertebral fractures who met the selection criteria and were admitted between November 2018 and January 2022. Among them, 34 patients were treated with sagittal top compression reduction technique (top pressure group), and 25 patients were treated with traditional reduction technique (traditional group). There was no significant difference in baseline data between the two groups ( >0.05), including gender, age, fracture segment, cause of injury, AO classification of thoracolumbar vertebral fractures, thoracolumbar injury classification and severity (TLICS) score, American Spinal Injury Association (ASIA) grading, surgical approach, preoperative vertebral body index, height ratio of the anterior margin of injured vertebra, injured vertebra angle, segmental kyphosis angle, visual analogue scale (VAS) score, and Oswestry disability index (ODI). The operation time, intraoperative blood loss, and incidence of complications between the two groups were recorded and compared. After operation, VAS score and ODI were used to evaluate effectiveness, and X-ray and CT examinations were performed to measure imaging indicators such as vertebral body index, height ratio of the anterior margin of injured vertebra, injured vertebra angle, and segmental kyphosis angle.
There was no significant difference in operation time and intraoperative blood loss between the two groups ( >0.05). No complication such as dural sac, nerve root, or vascular injury was found during operation, and all incisions healed by first intention. Patients in both groups were followed up 6-48 months, with an average of 20.6 months. No loosening, breakage, or failure of internal fixation occurred during follow-up. The imaging indicators, VAS score, and ODI of the two groups significantly improved at 1 week and last follow-up when compared to preoperative ones ( <0.05). At last follow-up, the VAS score and ODI further significantly improved when compared to 1 week after operation ( <0.05). At 1 week after operation and last follow-up, the vertebral body index, segmental kyphosis angle, injured vertebra angle, and ODI in the top pressure group were significantly better than those in the traditional group ( <0.05). There was no significant difference in VAS score and height ratio of the anterior margin of injured vertebra between the two groups at 1 week after operation ( >0.05), but the two indicators in the top pressure group were significantly better than those in the traditional group at last follow-up ( <0.05).
The treatment of thoracolumbar vertebral fractures with sagittal top compression reduction technique can significantly improve the quality of vertebral reduction, and is superior to traditional reduction techniques in relieving pain and improving spinal function.
探讨矢状位顶压复位技术治疗胸腰椎椎体骨折的疗效。
回顾性分析2018年11月至2022年1月收治的59例符合入选标准的胸腰椎椎体骨折患者的临床资料。其中，34例患者采用矢状位顶压复位技术治疗（顶压组），25例患者采用传统复位技术治疗（传统组）。两组患者的基线资料，包括性别、年龄、骨折节段、受伤原因、胸腰椎椎体骨折AO分类、胸腰椎损伤分类及严重程度（TLICS）评分、美国脊髓损伤协会（ASIA）分级、手术方式、术前椎体指数、伤椎前缘高度比值、伤椎角度、节段后凸角度、视觉模拟评分法（VAS）评分及Oswestry功能障碍指数（ODI），差异均无统计学意义（P>0.05）。记录并比较两组患者的手术时间、术中出血量及并发症发生率。术后采用VAS评分和ODI评估疗效，并通过X线和CT检查测量椎体指数、伤椎前缘高度比值、伤椎角度及节段后凸角度等影像学指标。
两组患者的手术时间和术中出血量差异无统计学意义（P>0.05）。术中未发现硬脊膜囊、神经根或血管损伤等并发症，所有切口均一期愈合。两组患者均随访6～48个月，平均20.6个月。随访期间未发生内固定松动、断裂或失效。与术前相比，两组患者在术后1周及末次随访时的影像学指标、VAS评分及ODI均显著改善（P<0.05）。与术后1周相比，末次随访时两组患者的VAS评分和ODI进一步显著改善（P<0.05）。术后1周及末次随访时，顶压组的椎体指数、节段后凸角度、伤椎角度及ODI均显著优于传统组（P<0.05）。术后1周时，两组患者的VAS评分及伤椎前缘高度比值差异无统计学意义（P>0.05），但末次随访时顶压组这两项指标均显著优于传统组（P<0.05）。
矢状位顶压复位技术治疗胸腰椎椎体骨折可显著提高椎体复位质量，在缓解疼痛及改善脊柱功能方面优于传统复位技术。
