经皮与开放椎弓根螺钉短节段固定治疗A1~A3型胸腰椎骨折近期疗效比较  

Comparison of short-time clinical efficacy of percutaneous and open pedicle screw fixation for type A1-A3 thoracolumbar fractures

作　　者：邢泽军 冀俊祥 郝帅[1] 陈晨[1] 冯皓宇[1] 马迅[1] Xing Zejun;Ji Junxiang;Hao Shuai;Chen Chen;Feng Haoyu;Ma Xun(Department of Orthopedics,Shanxi Academy of Medical Science,Shanxi Dayi Hospital,Taiyuan 030032, China;Department of Orthopedics,First People's Hospital of Yuanping ,Yuanping 034100,China)

机构地区：[1]山西医学科学院,山西大医院脊柱外科,太原030032 [2]山西省原平市第一人民医院骨科,034100

出　　处：《中华创伤杂志》2019年第1期14-21,共8页Chinese Journal of Trauma

摘　　要：目的探讨微创经皮与传统开放椎弓根螺钉短节段固定治疗A1~A3型胸腰椎压缩骨折的近期临床疗效。方法采用回顾性病例对照研究分析2012年1月-2017年2月山西大医院收治的64例胸腰椎压缩骨折患者临床资料,其中男44例,女20例;年龄21~65岁[(45.4±11.1)岁]。损伤节段:T111例,T1229例,L127例,L27例。骨折AO分型:A1型39例,A2型2例,A3型23例。37例采用微创经皮椎弓根螺钉短节段固定撑开复位治疗(微创手术组),27例采用传统开放椎弓根螺钉短节段固定撑开复位治疗(开放手术组)。记录两组手术时间、术中出血量、总住院时间、术后住院时间、手术前后视觉模拟评分(VAS)、伤椎椎体后凸角和矢状位节段性后凸Cobb角;观察并发症发生情况。结果患者均获随访12~29个月,平均13.2个月。微创手术组和开放手术组手术时间分别为(106.4±37.3)min和(131.3±33.6)min(P>0.05),术中出血量分别为(71.2±34.9)ml和(409.3±267.5)ml(P<0.05),总住院时间分别为(11.7±7.2)d和(21.6±12.8)d,术后住院时间分别为(8.1±7.4)d和(16.6±10.6)d(P<0.05)。微创手术组术前VAS为(6.5±1.1)分,术后即刻和末次随访分别为(2.3±0.7)分和(1.0±0.3)分;开放手术组分别为(6.9±1.0)分、(4.2±1.0)分和(0.9±0.4)分。两组术后即刻及末次随访与术前比较差异均有统计学意义(P<0.05),而两组间术前和末次随访比较差异均无统计学意义(P>0.05),而术后即刻两组间差异有统计学意义(P<0.05)。微创手术组伤椎椎体后凸角术前为(19.3±3.8)^°,术后即刻和末次随访分别为(3.4±1.7)^°和(4.6±1.9)^°;开放手术组分别为(19.6±6.8)^°、(1.6±0.8)^°和(2.4±1.1)^°。两组术后即刻和末次随访与术前比较差异均有统计学意义(P<0.05),而两组间比较差异均无统计学意义(P>0.05)。微创手术组矢状位节段性后凸Cobb角术前为(16.1±9.1)^°,术后即刻和末次随访分别为(3.0±1.8)^°和(5.9±1.8)^°;开放手术组分别为(15.2±1Objective To investigate the clinical efficacy of short segment fixation with percutaneous pedicle screws or traditional open surgery for the type A1-A3 thoracolumbar compression fracture. Methods A retrospective case control study was conducted on the clinical data of 64 patients with thoracolumbar compression fracture admitted to Shanxi Dayi Hospital between January 2012 and February 2017. There were 44 males and 20 females, aged 21-65 years [(45.4±11.1)years]. There was one patient with injured segment at T11, 29 at T12, 27 at L1 and seven at L2. According to AO typing, there were 39 patients classified as Type A1, two as Type A2 and 23 as Type A3. The patients were divided into minimally invasive surgery group (n=37) and open surgery group (n=27). Minimally invasive surgery group was treated with minimally invasive percutaneous pedicle screw fixation and open reduction. The open surgery group was treated with traditional open pedicle screw short segment fixation and open reduction. The operation time, intraoperative blood loss, total hospitalization time, postoperative hospitalization time, visual analogue scale (VAS) before and after operation, local kyphosis of the fractured vertebra, segmental kyphosis and complications in two groups were recorded. Results All patients were followed up for 12-29 months, with an average of 13.2 months. Between the minimally invasive surgery group and open surgery group, no significant difference was found in the operation time [(106.4±37.3)minutes vs.(131.3±33.6)minutes](P>0.05), and significant differences were found in intraoperative blood loss [(71.2±34.9)ml vs.(409.3±267.5)ml], total hospitalization time [(11.7±7.2)days vs. (21.6±12.8)days] and postoperative hospitalization time [(8.1±7.4)days vs. (16.6±10.6)days] (P<0.05). In the minimally invasive surgery group, VAS was (6.5±1.1)points preoperatively and was (2.3±0.7)points and (1.0±0.3)points immediately after operation and at final follow-up. In the open surgery group, VAS was (6.9±1.0)points preoperati

关 键 词：脊柱骨折 骨折固定术 内 椎弓根螺钉 

分 类 号：R687.3[医药卫生—骨科学]