张思齐,彭玉慧
ZHANG Siqi,PENG Yuhui

• 1:江苏省人民医院骨脊柱科

摘要(Abstract)：

目的探讨不同内固定手术联合量化评估疼痛知识教育干预对创伤性胸腰段骨折患者的治疗效果。方法选取骨脊柱科就诊的创伤性胸腰段骨折患者186例,分为传统组(传统切开椎弓根内固定治疗,n=93)和微创组(经皮微创脊柱内固定治疗,n=93),2组患者均实施基于量化评估的疼痛知识教育干预至出院;收集和比较2组患者手术时间、骨折愈合时间、住院时间、切口长度及术中出血量等手术相关指标;分别于术前、术后第1天及第7天,抽取2组患者空腹静脉血3 mL,采用酶联免疫吸附试验测定血清单核细胞趋化蛋白1(MCP-1)、白细胞介素1β(IL-1β)及高迁移率族蛋白B-1(HMGB-1)水平;采用视觉模拟疼痛评分(VAS)法分别评估于2组患者术前、术后第1天及第7天的疼痛程度;采用依从性指数(CI)评估2组患者住院期间的遵医行为并计算依从率。结果微创组创伤性胸腰段骨折患者手术时间、骨折愈合时间及住院时间均明显短于传统组,且术中出血量、切口长度均明显小于传统组(P <0.001); 2组创伤性胸腰段骨折患者术后第1天和第7天的血清MCP-1、IL-1β及HMGB-1水平均分别较与术前升高(P <0.05)、且术后第7天较术后第1天降低(P <0.05),微创组创伤性胸腰段骨折患者术后第1天和第7天的血清MCP-1、IL-1β及HMGB-1水平均明显低于传统组(P <0.001); 2组创伤性胸腰段骨折患者术后第1天和第7天的VAS评分均较术前降低(P <0.05),微创组创伤性胸腰段骨折患者术后第1天和第7天的VAS评分分别明显低于传统组(P <0.001);微创组创伤性胸腰段骨折患者的遵医行为依从率高于传统组,差异有统计学意义(P <0.05)。结论经皮微创脊柱内固定联合量化评估疼痛知识教育干预对创伤性胸腰段骨折患者的治疗效果优于传统切开椎弓根内固定联合量化评估疼痛知识教育干预,可降低患者血清MCP-1、IL-1β及HMGB-1水平,提高依从性和疼痛控制程度,促进术后恢复,缩短住院时间。
Objective To explore the therapeutic effect of different internal fixation operations on patients with traumatic thoracolumbar fractures who had implemented pain knowledge education intervention based on quantitative evaluation. Methods One hundred and eighty-six patients with traumatic thoracolumbar fractures were selected and divided into a traditional group and a minimally invasive group,each with 93 cases. The former group received traditional pedicle screw fixation whereas the latter group received minimally invasive percutaneous spinal fixation. Patients in both groups were given pain knowledge education intervention based on quantitative assessment before discharge from hospital. Operation-related indexes such as operative time,fracture healing time,hospitalization time,incision length and intraoperative blood loss were collected and compared. 3 mL fasting venous blood was collected from patients in the two groups before operation,1 d and 7 d after operation,respectively. The levels of serum monocyte chemoattractant protein 1(MCP-1),interleukin 1β(IL-1β) and high mobility group protein B-1(HMGB-1) were determined by enzyme-linked immunosorbent assay. Visual analogue scale(VAS) was used to evaluate the pain degree of the two groups before operation,1 d and 7 d after operation. The compliance index(CI) was used to evaluate the compliance behavior of patients in the two groups during hospitalization and to calculate the compliance rate. Results The operation time,fracture healing time and hospitalization time of patients with traumatic thoracolumbar fracture in the minimally invasive group were significantly shorter than those in the traditional group, and the intraoperative blood loss and incision length were significantly less than those in the traditional group(P < 0. 001). The levels of serum MCP-1,IL-1β,and HMGB-1 on 1 d and 7 d after operation in the two groups were higher than those before operation,and such levels on 7 d after operation were lower than those on 1 d after operation. The levels of serum MCP-1,IL-1β,and HMGB-1 on 1 d and 7 d after operation in the minimally invasive group were significantly lower than those in the traditional group. The VAS scores of both groups on 1 d and 7 d after operation were lowered than those before operation,and such scores in minimally invasive group were significantly lower than those in the traditional group(P < 0. 05). The compliance rate of minimally invasive group(95. 70%) was higher than that of traditional group(83. 87%),and the difference was statistically significant(P < 0. 05). Conclusion Minimally invasive percutaneous spinal fixation system can effectively reduce the level of serum MCP-1,IL-1β,HMGB-1 in patients with traumatic thoracolumbar fractures who have implemented pain knowledge education intervention based on quantitative evaluation,improve their compliance and pain control,promote postoperative recovery,and shorten the hospital stay.

关键词(KeyWords)： 白细胞介素1β;胸腰段骨折;经皮微创脊柱内固定;量化评估;单核细胞趋化蛋白-1;高迁移率族蛋白B-1
interleukin-1beta(IL-1β);thoracolumbar fractures;minimally invasive percutaneous spinal fixation;quantitative evaluation;monocyte chemotactic protein-1(MCP-1);high mobility group protein B-1(HMGB-1)

Abstract:

Keywords:

基金项目(Foundation): 江苏省科技项目(BK20190033)

作者(Author): 张思齐,彭玉慧
ZHANG Siqi,PENG Yuhui

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