经皮微创与常规切开椎弓根螺钉内固定治疗不稳定性胸腰椎骨折疗效比较  

Comparative study of minimally invasive percutaneous and conventional pedicle screw fixation for unstable thoracolumbar fractures

作　　者：张光祥 崔君智 ZHANG Guang-xiang;CUI Jun-zhi(Frist Department of Orthopaedics ,Ankang Traditional Chinese Medicine Hospital,Ankang 725000,Shaanxi,CHINA;Second Department of Orthopaedics ,Ankang Traditional Chinese Medicine Hospital,Ankang 725000,Shaanxi,CHINA)

机构地区：[1]安康市中医医院骨一科,陕西安康725000 [2]安康市中医医院骨二科,陕西安康725000

出　　处：《海南医学》2018年第24期3463-3466,共4页Hainan Medical Journal

基　　金：陕西省安康市科技计划项目(编号:2015AK04-13)

摘　　要：目的探讨不稳定性胸腰椎骨折采用经皮微创与常规切开椎弓根螺钉内固定的临床治疗效果。方法将2015年1月至2017年1月间安康市中医医院骨科诊治的不稳定性胸腰椎骨折患者70例根据随机数表法分为观察组和对照组各35例。观察组患者采用经皮微创椎弓根螺钉内固定术,对照组采用常规切开椎弓根螺钉内固定术,观察并比较两组患者的手术及治疗情况(手术时间、出血量、住院时间)、伤椎前缘高度比值以及椎管侵占率、Cobb's角均值的差异。比较手术前、术后1个月、6个月后VAS评分及神经功能评分(ASIA)的差异。结果观察组患者的术中出血量为(72.3±22.4) mL,明显低于对照组的(98.7±28.6) mL,住院时间为(9.7±2.6) d,明显短于对照组的(13.9±4.8) d,差异均有统计学意义(P<0.05);手术后,两组患者的伤椎前缘高度均明显提高,椎管侵占率均显著降低,术后1个月、3个月及6个月的Cobb's角均值均显著降低,差异均有统计学意义(P<0.05),但两组间比较差异均无统计学意义(P>0.05);与术前比较,两组患者术后1个月及6个月的VAS评分均显著降低,ASIA感觉、运动评分均显著升高,其中观察组术后1个月VAS评分(3.4±1.1)分,明显低于对照组的(5.1±1.4)分,差异有统计学意义(P<0.05),而两组患者的ASIA感觉和运动评分比较,差异均无统计学意义(P>0.05)。结论经皮微创椎弓根螺钉内固定术对不稳定性胸腰椎骨折疗效可靠,与常规切开椎弓根螺钉内固定比较,其手术时间短、术中出血少、疼痛程度低。Objective To investigate the effect of minimally invasive percutaneous and conventional pedicle screw fixation for unstable thoracolumbar fractures.Methods From January 2015 to January 2017,70 cases of unstable thoracolumbar fractures,who treated in Department of Orthopedics of Ankang Traditional Chinese Medicine Hospital,were selected and divided into the observation group and the control group according to random number table method,with 35 cases in each group.The observation group was treated with minimally invasive percutaneous pedicle screw fixation,and the control group was treated with conventional incision and pedicle screw fixation.The differences of operation and treatment (operation time,bleeding volume,hospitalization time),ratio of anterior height of injured vertebrae, spinal canal invasion rate and Cobb's angle mean value between the two groups were observed and compared.The Visual Analog Scale (VAS)scores and neurological American Spinal Injury Association (ASIA)scores were compared before operation,1 month and 6 months after operation.Results The blood loss in the observation group was (72.3±22.4)mL, which was significantly lower than (98.7±28.6)mL in the control group (P<0.05);the hospitalization time was (9.7±2.6)d, which was significantly shorter than (13.9±4.8)d of the control group (P<0.05).After operation,the anterior edge height of the injured vertebra in the two groups increased significantly,the spinal canal invasion rate decreased significantly, and the mean Cobb angle in the two groups at 1,3,6 months after treaement were significantly lower (P<0.05).But the difference between the two groups was not statistically significant (P>0.05).Compared with the preoperative,the scores of VAS in the two groups were significantly decreased at 1,6 months after treaement and the sensory and motor scores of ASIA were significantly increased.Compared with the control group,the VAS score in the observation group was (3.4±1.1),which was significantly lower than (5.1±1.4)in the control group at 1 mo

关 键 词：胸腰椎 骨折 微创 内固定 椎弓根 疗效 

分 类 号：R683.2[医药卫生—骨科学]