文章摘要

椎间盘损伤与胸腰椎骨折患者单纯后路短节段内固定后凸角变化的关系

作者: 1马新强, 1陶业伟, 1周占国, 1关涛
1 聊城市中医医院脊柱骨科,山东 聊城 252000
通讯: 马新强 Email: 95200765@qq.com
DOI: 10.3978/j.issn.2095-6959.2021.09.019

摘要

目的:探讨与胸腰椎骨折采用单纯后路短节段内固定后的后凸角变化及椎间盘损伤与患者发生后凸畸形的关系。方法:选取聊城市中医医院骨科手术治疗的134例胸腰椎骨折患者进行回顾性分析,其中70例患者并发椎间盘损伤(损伤组)、64例患者未并发椎间盘损伤(对照组),对比两组患者术前、术后3个月、术后6个月、术后12个月、取出内固定6个月后损伤的椎间盘后凸Cobb角;对比分析两组患者再发后凸畸形的发生率,根据患者是否发生后凸畸形建立logistic回归分析模型,分析椎间盘损伤与术后再发后凸畸形的关系。结果:损伤组和对照组在术前、术后3个月、术后6个月、术后12个月的Cobb角差异均无统计学意义(均P>0.05);在取出内固定6个月后,损伤组患者的Cobb角度大于对照组(P<0.05);取出内固定6个月后,损伤组患者后凸畸形发生率24.29%大于对照组的7.81%,差异具有统计学意义(P<0.05);再发后凸畸形患者与未发生后凸畸形患者的BMI、术前Cobb角、局部Cobb角(regional angle,RA)、伤椎前缘高度比(anterior vertebra height,AVH)、上位椎间盘角(upper intervertebral angle,UIVA)测定值比较,差异均有统计学意义(均P<0.05);两组年龄、性别、骨折椎体、骨折AO分型比较,差异均无统计学意义(均P>0.05)。Logistic回归模型结果显示:BMI、术前Cobb角、UIVA值增大及发生椎间盘损伤是单纯后路短节段内固定后再发后凸畸形的危险因素(P<0.05),AVH值增大是单纯后路短节段内固定后再发后凸畸形的保护性因素(P<0.05)。结论:椎间盘损伤会增大胸腰椎骨折患者采用单纯后路短节段内固定后再发后凸畸形的风险。
关键词: 椎间盘损伤;胸腰椎骨折;单纯后路短节段内固定;后凸畸形

Relationship between the injury of intervertebral disc and the change of kyphotic angle in patients with thoracolumbar fracture

Authors: 1MA Xinqiang, 1TAO Yewei, 1ZHOU Zhanguo, 1GUAN Tao
1 Department of Spine Orthopedics, Liaocheng Hospital of Traditional Chinese Medicine, Liaocheng Shandong 252000, China

CorrespondingAuthor: MA Xinqiang Email: 95200765@qq.com

DOI: 10.3978/j.issn.2095-6959.2021.09.019

Abstract

Objective: To explore the kyphotic angle changes of thoracolumbar fractures after simple posterior short-segment internal fixation and the relationship between the intervertebral disc injury and the occurrence of kyphotic deformity. Methods: This study selected 134 patients with thoracolumbar fractures treated by orthopedic surgery in our hospital for retrospective analysis. Among them, 70 patients had intervertebral disc injury (the injury group) and 64 patients did not have intervertebral disc injury (the control group). The kyphotic Cobb angles of the two groups were compared before operation, 3 months after operation, 6 months after operation, 12 months after operation, and 6 months after removal of internal fixation. The incidence of recurrence of kyphosis between the two groups was compared and analyzed. Logistic regression analysis model was established according to whether the patients had kyphosis, and the relationship between disc injury and recurrence of kyphosis after operation was analyzed. Results: There was no significant difference in Cobb angle between the injury group and the control group before operation, 3 months after operation, 6 months after operation, and 12 months after operation (P>0.05); 6 months after the internal fixation removed, the Cobb angle of the injury group was greater than that of the control group (P<0.05); 6 months after the internal fixation taken out, the incidence of kyphosis in the injury group (24.29%) was higher than that in the control group 7.81%, and the difference was statistically significant (P<0.05); comparison of BMI, preoperative Cobb angle, regional angle (RA), anterior vertebra height (AVH), upper intervertebral angle (UIVA) between patients with recurring kyphosis and those without kyphosis, the difference was statistically significant (P<0.05); there was no statistically significant difference in age, gender, fractured vertebral body, and fracture AO classification between the two groups (P>0.05); logistic regression model results showed that increased BMI, preoperative Cobb angle, UIVA value increase and intervertebral disc injury were risk factors for recurrence of kyphosis after simple posterior short-segment internal fixation (P<0.05) and increased AVH value was a protective factor for the recurrence of kyphosis after simple posterior short-segment internal fixation (P<0.05). Conclusion: Intervertebral disc injury will increase the risk of kyphosis after a short-segment posterior fixation for thoracolumbar fractures.
Keywords: intervertebral disc injury; thoracolumbar fracture; simple posterior short-segment internal fixation; kyphosis