经皮微创置入椎弓根螺钉内固定治疗胸腰椎骨折的临床疗效及对机体应激水平的影响  

Study on the clinical efficacy of minimally invasive percutaneous pedicle screw fixation in treatment of patients with thoracolumbar fractures and its influence on response level to stress

作　　者：杨贤玉 张长江 李来好 李洪珂 潘登 王鹏程 

机构地区：[1]平煤神马集团总医院脊柱骨病科,河南平顶山467000

出　　处：《临床和实验医学杂志》2015年第14期1173-1177,共5页Journal of Clinical and Experimental Medicine

基　　金：河南省自然科学基金项目(编号:0411044100)

摘　　要：目的探讨经皮微创置入椎弓根螺钉内固定治疗胸腰椎骨折的临床疗效及对机体应激反应的影响。方法将60例胸腰段骨折患者按照随机数字表法分为微创组30例和开放组30例,微创组采用经皮微创置入椎弓根螺钉内固定术,开放组采用传统开放手术,比较两组患者手术切口长度、手术时间、术中出血、术后引流量、住院时间、骨折愈合时间;分别于手术前、术后3 d、术后1年采用X线检查两组患者椎体前缘高度、后凸Cobb角、矢状面指数恢复情况,并于手术前、术后24 h、术后48 h检测患者血清肌酸激酶(CK)活性及C反应蛋白(CRP)水平。结果微创组手术切口长度、手术时间、术中出血量、引流量以及住院时间均显著低于开放组(P<0.05),两组间骨折愈合时间比较差异无统计学意义(P>0.05)。两组患者术后3 d、术后1年椎体前缘高度、矢状面指数均显著高于手术前,后凸Cobb角显著低于手术前,手术前后比较差异具有统计学意义(P<0.05);两组间手术前后各影像学指标比较差异无统计学意义(P>0.05)。微创组术后CK、CRP水平逐渐开始升高,至术后24 h达到峰值,之后开始降低;开放组术后CK、CRP水平持续升高;微创组术后各时段CK、CRP水平均显著低于开放组(P<0.05);两组间并发症发生率比较差异无统计学意义(χ2=1.071,P=0.301)。结论经皮微创置入椎弓根螺钉内固定术与传统开放手术疗效相当,而创伤更小,患者创伤应激反应更小,值得临床推广。Objective To explore the clinical efficacy of minimally invasive percutaneous pedicle screw fixation in treatment of patients with thoracolumbar fractures and its influence on response level to stress. Methods A total of 60 patients with thoracolumbar fractures were randomly divided into minimally invasive fixation group （n = 30 cases） and open surgery group （n = 30 cases ）, patients in minimally invasive fixation group underwent minimally invasive percutaneous pedicle screw fixation, and patients in open surgery group were treated with traditional open surgery, and the length of incision, operating time, volume of bleeding, postoperative drainage, hospitalization time and healing time of fracture in patients of these two groups were compared, X - ray examination was taken to check the front height, Cobb angle and sagittal recovery exponential of vertebral bodies before and in 3 d and 1 year after surgery, and CK activity and CRP level had been detected in patients of these two groups be- fore and at 24 h and 48 h after surgery. Results The length of minimally invasive incision, operating time, volume of blood loss, drainage and hospitalization time in minimally invasive fixation group were significantly lower than those of open surgery group （ P 〈 0.05 ）, and the difference in healing time of fractures between two groups was not statistically significant （ P 〉 0.05 ）. The front height and sagittal index of patients in 3 d and 1 year after surgery were significantly higher than those before surgery, and Cobb angle was significantly lower than that before surgery （ P 〈 0.05 ）. Levels of CK and CRP in patients of minimally invasive fixation group were gradually begun to rise, and reached the peak in 24 h after sur- gery, then they started to be decreased, and levels of CRP and CK in open surgery group kept sustained elevation, and levels of CRP and CK were significantly lower than those of open surgery group （ P 〈 0.05 ）. The difference in incidence of complications between these two

关 键 词：胸腰段骨折 内固定 椎弓根螺钉 应激反应 

分 类 号：R687.3[医药卫生—骨科学]