1、 1脊柱外科杂志，2023年2月，第21卷第1期 J Spinal Surg，February 2023，Vol.21，No.1O形臂导航辅助经皮椎弓根螺钉内固定术结合术前两步复位法治疗胸腰椎骨折韩松1，2，李红卫1，李宇卫1*，俞鹏飞11.南京中医药大学附属苏州市中医医院骨伤科，苏州 2150072.南京中医药大学附属宿迁市中医院骨伤科，宿迁 223800【摘要】目的探讨O形臂导航辅助经皮椎弓根螺钉内固定术结合术前两步复位法治疗胸腰椎骨折的临床疗效。方法2019年1月2021年12月，南京中医药大学附属苏州市中医医院收治无神经症状的单椎体胸腰椎压缩性骨折患者92例，采用随机数字表法分为2组，
2、一组采用O形臂导航辅助经皮椎弓根螺钉内固定术结合术前两步复位法治疗（联合组，n=46），另一组采用单纯O形臂导航辅助经皮椎弓根螺钉内固定术治疗（对照组，n=46）。记录2组手术时间，手术前后各时间点伤椎压缩率及后凸角。术后48 h在CT三维重建图像上观察椎弓根螺钉位置，并计算优良率。结果所有治疗顺利完成，患者随访 3个月。所有患者术后伤椎压缩率随时间推移有一定程度增加，但术后各时间点伤椎压缩率较术前降低，且联合组术后各时间点伤椎压缩率低于对照组，差异均有统计学意义（P 0.05）。2组患者根据术前伤椎压缩率分为2个亚组（30%术前伤椎压缩率 50%亚组和术前伤椎压缩率50%亚组），术后12周联
3、合组各亚组伤椎压缩率低于对照组，差异均有统计学意义（P 0.05）。所有患者置钉前及术后各时间点伤椎后凸角较术前降低，且联合组置钉前及术后各时间点伤椎后凸角小于对照组，差异均有统计学意义（P 0.05）。联合组置钉优良率明显高于对照组，差异有统计学意义（P 0.05）。结论O形臂导航辅助经皮椎弓根螺钉内固定术结合术前两步复位法治疗胸腰椎骨折可明显提高螺钉置入精准度，减少后期伤椎高度丢失，减小残存伤椎后凸角。【关键词】胸椎；腰椎；骨折，压缩性；手法，骨科；内固定器；外科手术，微创【中图分类号】R 683.2【文献标志码】A【文章编号】1672-2957（2023）01-0001-06【DOI】1
4、0.3969/j.issn.1672-2957.2023.01.001O-arm navigation assisted percutaneous pedicle screw internal fixation combined with preoperative two-step reduction for thoracolumbar fracturesHan Song1，2，Li Hongwei1，Li Yuwei1*，Yu Pengfei11.Department of Orthopaedics and Traumatology，Suzhou Hospital of Traditiona
5、l Chinese Medicine，Nanjing University of Traditional Chinese Medicine，Suzhou 215007，Jiangsu，China2.Department of Orthopaedics and Traumatology，Suqian Hospital of Traditional Chinese Medicine，Nanjing University of Traditional Chinese Medicine，Suqian 223800，Jiangsu，China【Abstract】ObjectiveTo investiga
6、te the clinical effect of O-arm navigation assisted percutaneous pedicle screw internal fixation combined with preoperative two-step reduction in the treatment of thoracolumbar fractures.MethodsFrom January 2019 to December 2021，Suzhou Hospital of Traditional Chinese Medicine affiliated to Nanjing U
7、niversity of Traditional Chinese Medicine treated 92 patients with single-segment thoracolumbar compression fracture without neurological symptoms，who were divided into 2 groups by random number table method.One group was treated with O-arm navigation assisted percutaneous pedicle screw internal fix
8、ation combined with preoperative two-step reduction（combined group，n=46），and the other group only with O-arm navigation assisted percutaneous pedicle screw internal fixation（control group，n=46）.The operation time，vertebral compression rate and kyphosis angle of injured vertebra were recorded before
9、and after operation.At postoperative 48 h，the pedicle screw position was observed on three-dimensional CT reconstruction images，and its excellent and good rate was calculated.ResultsAll the treatments were successfully completed，and all the patients were followed up for more than 3 months.The compre
10、ssion rate of injured vertebrae in all the patients increased after surgery over time，but the compression 临床研究*通信作者（Corresponding author）基金项目苏州市临床重点病种诊疗技术专项项目（LCZX202113）作者简介韩松（1980），硕士，主任医师；通信作者李宇卫 2韩松，等.O形臂导航辅助经皮椎弓根螺钉内固定术结合术前两步复位法治疗胸腰椎骨折rate of injured vertebrae at each time point after surgery wa
11、s lower than that before surgery，and the compression rate of injured vertebrae at each time point after surgery in the combined group was lower than that in the control group，and the differences were statistically significant（P 0.05）.The patients in the 2 groups were divided into 2 subgroups accordi
12、ng to the preoperative compression rate of injured vertebrae（30%preoperative compression rate of injured vertebrae 50%subgroup and preoperative compression rate of injured vertebrae50%subgroup）；at postoperative 12 weeks，the compression rate of injured vertebrae of each subgroup in the combined group
13、 was lower than that in the control group，and the differences were statistically significant（P 0.05）.The kyphosis angles of injured vertebrae in all the patients before screw placement and each time point after surgery were lower than those before surgery，and the kyphosis angles of injured vertebrae
14、 before screw placement and each time point after surgery in the combined group were lower than those in the control group，all with a statistically significant difference（P 0.05）.The excellent and good rate of screw position in the combined group was significantly higher than that in the control gro
15、up，and the difference was statistically significant（P 30%；骨折节段为T11 L4；年龄为18 70岁；美国脊髓损伤协会（ASIA）分级4为E级；胸腰椎损伤分型及评分系统（TLICS）评分54 6分。排除标准：妊娠期女性；合并严重心脑血管或其他基础疾病；合并骨质疏松症（骨密度T值-2.5）；合并精神障碍。根据上述标准，2019年1月2021年12月，南京中医药大学附属苏州市中医医院收治无神经症状的单椎体胸腰椎压缩性骨折患者92例，采用随机数字表法分为2组，一组采用O形臂导航辅助经皮椎弓根螺钉内固定术结合术前两步复位法治疗（联合组，n=46
16、），另一组单纯采用O形臂导航辅助经皮椎弓根螺钉内固定术治疗（对照组，n=46）。2组术前一般资料差异无统计学意义（P 0.05，表1），具有可比性。本研究经医院伦理委员会审核备案，患者及家属均知情同意，并签署知情同意书。表1 2组患者基线资料Tab.1 Baseline data of 2 groups组别Groupn性别Gender年龄/岁Age/year骨折节段SegmentTLICS评分TLICS score男Male女FemaleT11T12L1L2L3L4联合Combined46242252.057.79715136414.760.70对照Control46232356.416.99616146314.730.701.2 治疗方法联合组患者术前30 min采用两步复位法悬吊复位：患者取俯卧位，双手紧持床头栏杆，助手牵引双下肢，术者对骨折节段椎体进行按压复位（图1a），之后将患者轴位翻身至仰卧位（图1b），术者及助手立于患者两侧，将床单折叠成长条状，从患者后背与床面之间穿过，术者与助手各执一端，缓慢将床单两端向上抬起，使患者腰背部脱离床面，3脊柱外科杂志，2023年2月，第21
