反向预弯钛棒在单节段胸腰椎压缩骨折治疗中的应用

摘要

Objective To evaluate the clinical efficacy of reverse pre⁃bent titanium rod in the treat⁃ment of thoracolumbar compression fractures. Methods The clinical data of 168 patients with thoracolumbar compression fractures from June 2009 to October 2013 were retrospectively analyzed. All the cases were divid⁃ed into two groups by titanium rods preflex direction, including reverse pre⁃bending group (n=84, anti⁃fracture compression direction, like a“C”) and the positive pre⁃bending group (n=84, cis lordosis group, like a“S”or“anti⁃C”). Oswestry disability index (ODI), sagittal Cobb angle, vertebral height ratio, and fixation failure rate af⁃ter operation were compared between two groups. Results The patients had an average follow⁃up period of 18.6 months (13⁃28 months). At the final follow⁃up, the fixation failure rate in reverse pre⁃bending group and positive pre⁃bending group was 6.0%(5/84) and 4.8%(4/84) respectively (χ2=0.085, P=0.776). The ODI in the two groups showed no significant difference between preoperation and final follow⁃up. Regardless of preopera⁃tion and postoperation, the leading edge of the vertebral height ratio, and sagittal Cobb angle showed no statisti⁃cally significant difference between two group, but at final follow⁃up, there was statistically significant differ⁃ence between two groups. In the reverse pre⁃bending group, there was no significant difference in the values im⁃mediately after operation and at the final follow⁃up, but in the positive pre⁃bending group, there was significant difference. Conclusion The reverse preflex titanium rod in the treatment of thoracolumbar compression frac⁃tures can effectively maintain the vertebral height, reducing the incidence of kyphosis.%目的：探讨反向预弯钛棒治疗胸腰椎压缩性骨折的临床疗效。方法回顾性分析2009年6月至2013年10月的168例胸腰椎压缩性骨折患者的临床资料，按照钛棒的预弯方向分为反向预弯组84例（反骨折压缩方向，呈“C”形）及正向预弯组84例（顺生理曲度组，呈“S”形或反“C”形）。比较两组患者术后的Oswestry功能障碍指数（Oswestry disability index, ODI）、矢状面Cobb角、椎体前缘高度比和内固定失败率。结果本组患者平均随访18.6个月（13～28个月），末次随访时，反向预弯组的内固定失败发生率为6.0%（5/84），正向预弯组的内固定失败发生率为4.8%（4/84），差异无统计学意义（χ2=0.085，P=0.776），术前及术后末次随访时两组ODI差异无统计学意义。在伤椎前缘高度比、矢状面Cobb角的比较中，反向预弯组与正向预弯组比较，术前、术后即刻的数值差异均无统计学意义，但两者末次随访时的差异均具有统计学意义；反向预弯组内术后即刻与末次随访时的数值比较，差异均无统计学意义，但正向预弯组的术后即刻与末次随访时的数值的差异具有统计学意义。结论反向预弯钛棒治疗胸腰椎压缩性骨折可有效维持椎体高度，减少脊柱后凸畸形的发生率，值得推广。