| 摘要: |
| 目的 分析不同入路法联合小针刀术在胸腰椎创伤性骨折微创椎弓根钉内固定术中的临床疗效，以及对血清骨特异性碱性磷酸酶(BALP)、Ⅰ型胶原羧基肽β特殊序列(β-CTX)水平的影响。方法:选取我院2020年1月—2022年6月收治的120例行微创椎弓根钉内固定术联合下针刀术干预治疗的胸腰椎创伤性骨折患者，随机分为三组。A组(40例)选择经皮入路，B组(40例)选择经Wiltse入路，C组(40例)选择经后正中入路。记录并比较三组伤椎有效性指标:Oswestry功能障碍指数(ODI)、后凸Cobb角和前缘高度比；视觉模拟疼痛(VAS)评分、血清BALP、β-CTX水平和围手术期指标(手术时间、术中出血量和术后引流量)。结果:三组患者术后7 d、30 d的伤椎ODI、后凸Cobb角和前缘高度比均优于术前，差异有统计学意义(P<0.05)，但三组间伤椎ODI、后凸Cobb角和前缘高度比较差异无统计意义(P＞0.05)；三组患者术后VAS评分均显著下降，差异有统计学意义(P<0.05)，且三组术后1 d、7 d的VAS评分比较差异有统计意义(P <0.05)；三组患者术后血清BALP水平均明显上升，血清β-CTX水平均明显下降，差异均有统计学意义(P <0.05)，且三组术后7 d的血清BALP及β-CTX水平比较差异有统计意义(P<0.05)；三组手术时间、术中出血量和术后引流量关系为A组＜B组＜C组，差异有统计学意义(P<0.05)。结论:经皮入路和经Wiltse入路微创椎弓根钉内固定术联合小针刀术干预治疗能有效改善胸腰椎创伤性骨折患者伤椎有效性及骨代谢水平，而传统后正中入路的有效性及对骨代谢水平的改善作用相对较差，临床可结合患者情况在经皮入路和经Wiltse入路二者之间酌情选择入路方式，并结合小针刀术进行干预治疗。 |
| 关键词: 胸腰椎创伤性骨折 微创椎弓根钉内固定术 小针刀术 骨特异性碱性磷酸酶 Ⅰ型胶原羧基肽β特殊序列 |
| DOI：10.3969/j.issn.1007-6948.2024.02.014 |
| 投稿时间：2023-08-28 |
| 基金项目:河北省中医药科学研究重点课题计划(2021414) |
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| Study on the therapeutic effect of different approaches combined with small needle knife surgery in minimally invasive pedicle screw internal fixation for thoracolumbar traumatic fractures |
| PEI Qiu-yan，ZHENG Tao，LI Zhi-gang |
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| Abstract: |
| Objective To analyze Comparison of ODI, serum BALP, and therapeutic effects of different approaches combined with small needle knife surgery in minimally invasive pedicle screw fixation of thoracolumbar traumatic fractures. Methods We selected 120 patients with thoracolumbar traumatic fractures who underwent minimally invasive pedicle screw internal fixation combined with needle knife intervention treatment in our hospital from January 2020 to June 2022 as the research subjects, All patients received minimally invasive pedicle screw internal fixation. Randomly divide into three groups. Group A (40 cases) chose percutaneous approach, group B (40 cases) via Wiltse approach, and group C (40 cases) via posterior median approach. Observe and record the three groups of injury vertebral effectiveness indexes [Oswestry disability index (ODI), kyphotic Cobb angle and front edge height ratio], visual analogue scale (VAS) score, serum BALP and β -CTx level and perioperative indicators [operation time, intraoperative blood loss and postoperative drainage], and then perform statistical analysis. Results The three groups of injured vertebra ODI, kyphotic Cobb angle and front edge height ratio were significantly optimized (P<0.05), but there was no statistical difference between the three groups of injured vertebra ODI, kyphotic Cobb angle and front edge height ratio significance (P>0.05).The postoperative VAS scores of the three groups all decreased significantly (P<0.05), and the difference in the VAS scores of the three groups at 1 and 7 days after surgery was statistically significant (P<0.05).The levels of serum BALP and β - CTX in the three groups were significantly increased (P < 0.05), and the serum levels of β - CTX were significantly decreased (P < 0.05), and there were statistically significant differences in serum BALP and β - CTX levels among the three groups on the 7th day after operation (P < 0.05).The operation time, intraoperative blood loss and postoperative drainage volume of the three groups of patients showed obvious signs of group A
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| Key words: Traumatic fracture of thoracolumbar spine minimally invasive pedicle screw internal fixation small needle knife technique bone isoenzyme alkaline phosphatase beta C-terminal cross-linked telopeptides of typeⅠcollagen |
