Objective: To investigate the effectiveness of sagittal top compression reduction technique in the treatment of thoracolumbar vertebral fractures.
Methods: A retrospective analysis was conducted on the clinical data of 59 patients with thoracolumbar vertebral fractures who met the selection criteria and were admitted between November 2018 and January 2022. Among them, 34 patients were treated with sagittal top compression reduction technique (top pressure group), and 25 patients were treated with traditional reduction technique (traditional group). There was no significant difference in baseline data between the two groups ( P>0.05), including gender, age, fracture segment, cause of injury, AO classification of thoracolumbar vertebral fractures, thoracolumbar injury classification and severity (TLICS) score, American Spinal Injury Association (ASIA) grading, surgical approach, preoperative vertebral body index, height ratio of the anterior margin of injured vertebra, injured vertebra angle, segmental kyphosis angle, visual analogue scale (VAS) score, and Oswestry disability index (ODI). The operation time, intraoperative blood loss, and incidence of complications between the two groups were recorded and compared. After operation, VAS score and ODI were used to evaluate effectiveness, and X-ray and CT examinations were performed to measure imaging indicators such as vertebral body index, height ratio of the anterior margin of injured vertebra, injured vertebra angle, and segmental kyphosis angle.
Results: There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05). No complication such as dural sac, nerve root, or vascular injury was found during operation, and all incisions healed by first intention. Patients in both groups were followed up 6-48 months, with an average of 20.6 months. No loosening, breakage, or failure of internal fixation occurred during follow-up. The imaging indicators, VAS score, and ODI of the two groups significantly improved at 1 week and last follow-up when compared to preoperative ones ( P<0.05). At last follow-up, the VAS score and ODI further significantly improved when compared to 1 week after operation ( P<0.05). At 1 week after operation and last follow-up, the vertebral body index, segmental kyphosis angle, injured vertebra angle, and ODI in the top pressure group were significantly better than those in the traditional group ( P<0.05). There was no significant difference in VAS score and height ratio of the anterior margin of injured vertebra between the two groups at 1 week after operation ( P>0.05), but the two indicators in the top pressure group were significantly better than those in the traditional group at last follow-up ( P<0.05).
Conclusion: The treatment of thoracolumbar vertebral fractures with sagittal top compression reduction technique can significantly improve the quality of vertebral reduction, and is superior to traditional reduction techniques in relieving pain and improving spinal function.
目的: 探讨经伤椎矢状面顶压复位技术治疗胸腰椎骨折的临床疗效。.
方法: 回顾分析2018年11月—2022年1月收治且符合选择标准的59例胸腰椎骨折患者临床资料，其中34例采用经伤椎矢状面顶压复位技术治疗（顶压组），25例采用传统复位技术治疗（传统组）。两组患者性别、年龄、骨折节段、致伤原因、胸腰椎骨折AO分型、胸腰椎损伤分类和严重程度（TLICS）评分、美国脊柱损伤协会（ASIA）分级、手术入路及术前椎体指数、伤椎前缘高度比值、伤椎成角、节段后凸角、疼痛视觉模拟评分（VAS）及Oswestry功能障碍指数（ODI）等基线资料比较差异均无统计学意义（ P>0.05）。记录并比较两组手术时间、术中出血量及并发症发生情况；术后采用VAS评分及ODI评价临床疗效，行X线片及CT检测并测量椎体指数、伤椎前缘高度比值、伤椎成角、节段后凸角等影像学指标。.
结果: 两组手术时间、术中出血量比较差异均无统计学意义（ P>0.05）。术中无硬膜囊、神经根、血管损伤等并发症发生，术后切口均Ⅰ期愈合。两组患者均获随访，随访时间6～48个月，平均20.6个月。均未发生内固定物松动、断裂及固定失效等情况。两组患者术后1周及末次随访时各影像学指标及VAS评分、ODI均较术前显著改善，末次随访时VAS评分、ODI较术后1周进一步改善，差异均有统计学意义（ P<0.05）。术后1周及末次随访时，顶压组椎体指数、节段后凸角、伤椎成角及ODI均优于传统组，差异有统计学意义（ P<0.05）；术后1周两组VAS评分及伤椎前缘高度比值比较差异无统计学意义（ P>0.05），但末次随访时顶压组均优于传统组，差异有统计学意义（ P<0.05）。.
结论: 经伤椎矢状面顶压复位技术治疗胸腰椎骨折可明显提高椎体复位质量，在缓解疼痛及改善脊柱功能方面优于传统复位技术。.
Keywords: Thoracolumbar vertebral fracture; injured vertebra; top compression reduction technique.