CAJ | 학술논문

背景：应用椎弓根钉内固定系统修复胸腰椎骨折能有效地恢复椎体的高度及生理弧度，被广泛运用于临床。临床工作中发现不同修复方式对椎体高度恢复存在差异，同时患者在修复前的各种相关因素存在差异,导致修复后椎体高度恢复的程度亦不一致。 　　目的：探讨应用椎弓根螺钉内固定系统修复胸腰椎骨折影响椎体高度恢复的相关因素。 　　方法：总结2012年9月至2015年3月应用后路复位椎弓根螺钉内固定系统修复胸腰椎骨折63例患者的临床资料，骨折类型均为AO Spine胸腰椎损伤分类系统中的A3、A4型，根据修复方式将患者分为两组，经伤椎固定组32例，跨伤椎固定组31例。分别记录两组患者的年龄、病程(3周以内)、骨密度、治疗前椎体压缩程度、治疗前矢状面Cobb角等指标，观察患者治疗后压缩椎体高度恢复情况，应用独立样本t检验行组间分析，组内应用双变量回归分析行单因素分析，应用多元线性回归分析行多因素分析，探讨影响椎体高度恢复的相关因素。 　　结果与结论：两组患者治疗前椎体压缩率及Cobb角比较差异无显著性意义(P >0.05)，治疗后经伤椎固定组椎体高度恢复率明显大于跨伤椎固定组，差异有显著性意义(P <0.05)。组内单因素分析结果显示患者的病程、治疗前椎体压缩程度、骨密度与治疗后椎体高度恢复情况有一定的相关性(P <0.05)，而患者的年龄、治疗前矢状面Cobb角与治疗后椎体高度恢复情况无相关性(P >0.05)。多因素分析结果显示，患者治疗前椎体压缩程度、病程是影响治疗后椎体高度恢复情况的主要因素，其标准化偏回归系数分别为0.225，-0.621。提示经伤椎置钉椎弓根内固定较传统的跨伤椎固定能更有效的恢复压缩椎体的高度。患者治疗前椎体压缩程度、病程是影响椎体高度恢复的主要因素，观察这些指标有助于预测修复后椎体高度恢复情况。揹景：應用椎弓根釘內固定繫統脩複胸腰椎骨摺能有效地恢複椎體的高度及生理弧度，被廣汎運用于臨床。臨床工作中髮現不同脩複方式對椎體高度恢複存在差異，同時患者在脩複前的各種相關因素存在差異,導緻脩複後椎體高度恢複的程度亦不一緻。 　　目的：探討應用椎弓根螺釘內固定繫統脩複胸腰椎骨摺影響椎體高度恢複的相關因素。 　　方法：總結2012年9月至2015年3月應用後路複位椎弓根螺釘內固定繫統脩複胸腰椎骨摺63例患者的臨床資料，骨摺類型均為AO Spine胸腰椎損傷分類繫統中的A3、A4型，根據脩複方式將患者分為兩組，經傷椎固定組32例，跨傷椎固定組31例。分彆記錄兩組患者的年齡、病程(3週以內)、骨密度、治療前椎體壓縮程度、治療前矢狀麵Cobb角等指標，觀察患者治療後壓縮椎體高度恢複情況，應用獨立樣本t檢驗行組間分析，組內應用雙變量迴歸分析行單因素分析，應用多元線性迴歸分析行多因素分析，探討影響椎體高度恢複的相關因素。 　　結果與結論：兩組患者治療前椎體壓縮率及Cobb角比較差異無顯著性意義(P >0.05)，治療後經傷椎固定組椎體高度恢複率明顯大于跨傷椎固定組，差異有顯著性意義(P <0.05)。組內單因素分析結果顯示患者的病程、治療前椎體壓縮程度、骨密度與治療後椎體高度恢複情況有一定的相關性(P <0.05)，而患者的年齡、治療前矢狀麵Cobb角與治療後椎體高度恢複情況無相關性(P >0.05)。多因素分析結果顯示，患者治療前椎體壓縮程度、病程是影響治療後椎體高度恢複情況的主要因素，其標準化偏迴歸繫數分彆為0.225，-0.621。提示經傷椎置釘椎弓根內固定較傳統的跨傷椎固定能更有效的恢複壓縮椎體的高度。患者治療前椎體壓縮程度、病程是影響椎體高度恢複的主要因素，觀察這些指標有助于預測脩複後椎體高度恢複情況。
배경：응용추궁근정내고정계통수복흉요추골절능유효지회복추체적고도급생리호도，피엄범운용우림상。림상공작중발현불동수복방식대추체고도회복존재차이，동시환자재수복전적각충상관인소존재차이,도치수복후추체고도회복적정도역불일치。 　　목적：탐토응용추궁근라정내고정계통수복흉요추골절영향추체고도회복적상관인소。 　　방법：총결2012년9월지2015년3월응용후로복위추궁근라정내고정계통수복흉요추골절63례환자적림상자료，골절류형균위AO Spine흉요추손상분류계통중적A3、A4형，근거수복방식장환자분위량조，경상추고정조32례，과상추고정조31례。분별기록량조환자적년령、병정(3주이내)、골밀도、치료전추체압축정도、치료전시상면Cobb각등지표，관찰환자치료후압축추체고도회복정황，응용독립양본t검험행조간분석，조내응용쌍변량회귀분석행단인소분석，응용다원선성회귀분석행다인소분석，탐토영향추체고도회복적상관인소。 　　결과여결론：량조환자치료전추체압축솔급Cobb각비교차이무현저성의의(P >0.05)，치료후경상추고정조추체고도회복솔명현대우과상추고정조，차이유현저성의의(P <0.05)。조내단인소분석결과현시환자적병정、치료전추체압축정도、골밀도여치료후추체고도회복정황유일정적상관성(P <0.05)，이환자적년령、치료전시상면Cobb각여치료후추체고도회복정황무상관성(P >0.05)。다인소분석결과현시，환자치료전추체압축정도、병정시영향치료후추체고도회복정황적주요인소，기표준화편회귀계수분별위0.225，-0.621。제시경상추치정추궁근내고정교전통적과상추고정능경유효적회복압축추체적고도。환자치료전추체압축정도、병정시영향추체고도회복적주요인소，관찰저사지표유조우예측수복후추체고도회복정황。
BACKGROUND:Pedicle screw fixation in the treatment of thoracolumbar fracture can effectively restore vertebral body height and physiological radian, and are widely used in the clinic. In the clinic, we found that different surgical methods on restoration of vertebral height are different. Simultaneously, there are differences in relevant factors before repair, which causes that the recovery of vertebral body height is not consistent. OBJECTIVE:To explore the related factors influencing the recovery of vertebral height of pedicle screw fixation system for treating thoracolumbar fracture. METHODS:Clinical data of 63 patients with thoracolumbar fracture, who were treated by posterior pedicle screw fixation system from September 2012 to March 2015, were summarized. The fracture types were A3 or A4 type in the AO spine thoracolumbar injury classification system, including 32 cases of transpedicular screw fixation (group A) and 31 cases of beyond-injured-vertebral fixation (group B). The related factors including age, course of disease (within 3 weeks), bone mineral density, preoperative degree of vertebral compression and preoperative sagittal Cobb’s angle were recorded. The degree of vertebral height restoration was also observed. Intergroup analysis was conducted using independent samplet-test. Intragroup analysis was performed using bivariate regression analysis in single factor analysis. Multivariate linear regression analysis was applied for multivariate analysis so as to explore the factors related to vertebral height restoration. RESULTS AND CONCLUSION:No significant difference in preoperative rate of vertebral compression or Cobb’s angle was detected between the two groups (P > 0.05). Postoperative rate of vertebral height restoration of group A was significantly greater than group B (P < 0.05). Univariate analysis within the group showed that course of disease, preoperative degree of vertebral compression and bone mineral density were strongly associated with the restoration of vertebral height (P < 0.05). In contrast, there was no significant correlation between age, preoperative sagittal Cobb’s angle and the restoration of vertebral height (P > 0.05). Multiple linear regression analysis showed that the preoperative degree of vertebral compression and the course of disease were the predominant factors affecting the vertebral height restoration. The standardized partial regression coefficients were 0.225, -0.621, respectively. These results demonstrate that transpedicular screw fixation can more effectively restore vertebral height than traditional beyond-injured-vertebral internal fixation. The preoperative vertebral compression and course of diseases are the predominant factors affecting the vertebral height restoration, which can predict postoperative vertebral height restoration.