摘要
目的:分析腰椎骨折后路短节段固定术后矫正丢失情况并分析影像学相关因素。方法:对2015年1月至2018年12月行后路短节段固定的48例腰椎骨折患者的影像学资料进行回顾性分析,其中男32例,女16例;年龄23~60(45.98±8.20)岁;骨折节段为L2-L4。测量术前、术后1周、末次随访时伤椎前缘高度(anterior vertebrae height,AVH),伤椎体楔变角(vertebral wedge angle,VWA)及局部后凸角(local kyphosis angle,LKA)并计算随访中局部椎间盘角度(segmental discal angle,SDA),LKA,AVH的丢失(分别表示为LoSAD,LoLKA,LoAVH);评估术前载荷分享评分(load-sharing scores,LSS),胸腰段脊柱脊髓损伤分类及严重程度评分(the thoracolumbar injury classification and severity score,TLICS)和邻近椎间盘损伤(intervertebral disc injuries,IDIs)。分析年龄,随访时间,LSS,TLICS,IDIs与矫正丢失的相关性。结果:48例患者均获随访,时间12~18(16.13±5.39)个月。术后1周及末次随访LKA,AVH,VWA较术前均明显改善(P<0.05)。末次随访LKA较术后1周丢失(5.70±3.17)°,末次随访AVH较术后1周丢失(4.31±5.95)%,差异均有统计学意义(P<0.05);但术后1周和末次随访VWA差异无统计学意义(P>0.05)。LoSDA(r=0.706,0.579,0.449)和LoLKA随LSS、TLICS和IDIs增加而加重,LoAVH随LSS、TLICS增加而加重(P<0.05)。多因素Logistic回归分析显示,LSS评分增加均为LoSDA、LoLKA、LoAVH的危险因素(P<0.05)。结论:后路短节段椎弓根钉治疗下腰椎骨折术后邻近椎间盘角度和伤椎高度有不同程度丢失,且多因素分析提示均与骨折的载荷分享评分有相关性。
Objective:To analyze the correction loss after posterior segmental fixation for lumbar spine fractures and explore the related image factors.Methods:Posterior short-segment fixation was received in 48 patients with L2-L4 fractures.There were 32 males and 16 females,with ages of 23 to 60(45.98±8.20)yeaes.The anterior vertebrae height(AVH),vertebral wedge angle(VWA)of the injured vertebra and local kyphosis angle(LKA)were measured before operation,1 week after operation and the final follow-up.The loss of segmental discal angle(LoSDA),LKA(LoLKA),AVH(LoAVH)were calculated between 1 week postoperative and the last follow-up.Preoperative load-sharing scores(LSS),TLICS scores,and adjacent intervertebral disc injuries(IDIs)were assessed.Then the correlation between the age,follow-up time,LSS,TLICS,IDIs and the correction loss was analyzed.Results:The average follow-up was 12 to 18(16.13±5.39)months.LKA,AVH and VWA at 1 week postoperative and those at the final follow-up,were significantly improved compared with those preoperative(P<0.05).In the final follow-up,the average LKA(5.70±3.17)°and AVH(4.31±5.95)%correction loss were observed compared with those 1 week postoperative(P<0.05).Otherwise the lose of VWA was not obvious(P>0.05).Univariate analysis showed that the SDA(r=0.706,0.579,0.449)and LKA(r=0.715,0.566,0.502)correction loss were aggravated with the increase of LSS,TLICS and IDIs,and AVH(r=-0.325,-0.219)correction loss was aggravated with the increase of LSS and TLICS(P<0.05).Multivariate analysis showed that increased LSS scores were all risk factors for segmental disc angle(SDA)loss,LKA correction loss,and AVH correction loss(P<0.05).Conclusion:The angle of adjacent intervertebral discs and anterior height of injured vertebrae were lost statistically after posterior short-segment pedicle screw treatment for lumbar fractures,and multivariate analysis showed that all of them were correlated with load-sharing score.
作者
周茂生
杨民
丁国正
王林
谢加兵
陆汉力
ZHOU Mao-sheng;YANG Min;DING Guo-zheng;WANG Lin;XIE Jia-bing;LU Han-li(Trauma Department of Orthopaedics,the First Affiliated Hospital,Yijishan Hospital,Wannan Medical College,Wuhu 241000,Anhui,China)
出处
《中国骨伤》
CAS
CSCD
2021年第7期654-658,共5页
China Journal of Orthopaedics and Traumatology
