无神经功能障碍胸腰段屈曲牵张型损伤:经皮与开放椎弓根螺钉固定的比较研究  

Thoracolumbar flexion-distraction injury without neurological impairment: comparison of percutanuous pedicle screw and open surgery

作　　者：张志成[1] 李放[1] 任大江[1] 杜培[1] 李连华[1] 孙天胜[1] 

机构地区：[1]北京军区总医院全军骨科研究所,100700

出　　处：《中国矫形外科杂志》2015年第12期1063-1067,共5页Orthopedic Journal of China

基　　金：首都市民健康项目培育(编号:Z131100006813029)

摘　　要：[目的]分析比较无神经功能障碍胸腰段屈曲牵张型损伤行经皮椎弓根螺钉技术和开放融合手术的临床疗效。[方法]回顾分析2008~2013年间,本院进行手术治疗获得1年以上随访的无神经功能障碍屈曲牵张型损伤患者45例,分为2组,经皮椎弓根螺钉治疗组和开放手术组。对比分析患者手术时间、术中出血量、住院时间、术后切口疼痛;测量并比较术前、术后伤椎前缘高度、后凸角度及术后损伤节段中柱高度,观察骨折愈合情况。[结果]手术时间两组间比较差异没有统计学意义（P=0.52）。术中出血量经皮组明显低于开放组（P=0.00〈0.05）。术后切口疼痛在术后第2 d,开放组明显高于经皮组（P=0.01〈0.05）,但在出院时两组差异没有统计学意义（P=0.50）。开放组住院时间长于经皮组（P=0.04〈0.05）。两组术前后凸畸形（P=0.36）及伤椎前缘高度差异无统计学意义（P=0.45）,术后1个月（P=0.70和P=0.23）及术后12个月（P=0.69和P=0.86）两组间比较差异无统计学意义,但均较术前明显缓解。术后损伤运动节段中柱高度两组间差异没有统计学意义（P=0.46）。术后无神经功能障碍及切口感染,随访期间内固定位置良好,无内固定失败病例。[结论]经皮椎弓根螺钉技术具有出血少、术后疼痛轻、住院时间短的优点,可以作为无神经功能障碍胸腰段屈曲牵张损伤的一种治疗选择。[Objective]To compare the clinical effects of percutanuous pedicle screw fixation with open fusion and fixation in treatment of thoracolumbar flexion- distraction injury without neurological impairment. [Method]From 2008 to 2013,45 patients of thoracolubar flexion- distraction injury without neurological impairment were treated with surgery and retrospectively analyzed in our hospital with more than one year follow-up. These patients were divided into two groups： percutaneous pedicle screw fixation group and open surgery group. The operative time,blood loss,hospital stay,postoperative wound pain were recorded and compared. The preoperative and postoperative injured vertebral anterior height,kyphosis,and the postoperative middle column height of the injured segments,and fracture healing status were measured and compared. [Result]There was no statistically significant difference between the two groups in operative time（ P = 0. 52）. Intraoperative blood loss in pecutaneous group was significantly lower than in the open group（ P = 0. 00 0. 05）. About incision pain in two day after surgery,the open group was significantly higher than the percutaneous group（ P = 0. 01〈0. 05）,but the pain had no statistically significant difference（ P = 0. 50） in the two groups at discharge. Hospitalization time were longer in open group（ P = 0. 04 0. 05）. There were no significant difference in the two goups on injured vertebral anterior height and kyphosis before surgery（ P = 036,P = 0. 45）,one month after surgery（ P = 0. 70,P = 0. 23）,and 12 months after surgery（ P = 0. 69,P = 0. 86）. However,these value were all better than before surgery. The postoperative middle column height of the injured segments between the two groups was not statistically significant（ P = 0. 46）. There was no cases of neurological function deterioration and wound infection. The internal fixation position was good in follow- up. There was no implant failures. [Conclusion]Percutaneous pedicle screw technique has advantage

关 键 词：胸腰椎 屈曲牵张损伤 微创 经皮椎弓根固定 

分 类 号：R687.3[医药卫生—骨科学]