一种新型胸腰椎骨折经皮椎弓根螺钉复位内固定体外撑开器的设计与临床应用研究  

Design and clinical application of a new extracorporeal reduction device for percutaneous pedicle screw fixation in treatment of thoracolumbar fractures

作　　者：邹伟[1] 肖杰[1] 龙浩[1] 何辉[1] 吴陈[1] 冯明星[1] 周昌俊[1] 

机构地区：[1]贵阳市第四人民医院(贵阳骨科医院)脊柱外科,贵阳550002

出　　处：《中国修复重建外科杂志》2017年第1期66-72,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：贵阳市科技计划项目([20141001]20)~~

摘　　要：目的设计一种新型经皮椎弓根螺钉复位内固定体外撑开器(简称"新型撑开器"),评价其应用于胸腰椎骨折治疗的疗效。方法根据胸腰椎骨折机制和复位力学特点,自行设计新型撑开器,并结合U形长尾空心椎弓根钉棒系统,于2014年1月—2016年1月采用经皮微创椎弓根螺钉复位内固定治疗36例单节段无神经损伤胸腰椎骨折患者(A组),并与同期采用传统开放椎弓根螺钉复位内固定治疗的39例胸腰椎骨折患者(B组)临床资料进行比较。两组患者性别、年龄、致伤原因、骨折分型、骨折节段、受伤至手术时间以及术前伤椎前、中、后缘高度百分比和伤椎后凸角比较差异均无统计学意义(P>0.05),具有可比性。记录并比较两组手术时间、切口长度、术中出血量、术后引流量、术后24 h切口疼痛视觉模拟评分(VAS)、患者X射线暴露次数、离床下地活动时间及术后伤椎前、中、后缘高度百分比、后凸角及矫正度。结果 A组手术时间、手术切口长度、术中出血量、术后引流量、术后24 h伤口VAS评分、离床下地活动时间均优于B组,B组患者X射线暴露次数优于A组,差异均有统计学意义(P<0.05)。两组患者均获随访,随访时间7~15个月,平均11.2个月。均未出现医源性神经根损伤及术后感染、内植物断裂、折弯等术中及术后并发症。A组1例术中出现2枚椎弓根螺钉轻度拔钉。两组术后3 d伤椎前、中、后缘高度百分比及伤椎后凸角均较术前显著改善(P<0.05);但术后3 d两组间上述指标及伤椎后凸角矫正度比较差异均无统计学意义(P>0.05)。结论与传统开放椎弓根螺钉复位内固定比较,应用新型撑开器经皮微创椎弓根螺钉复位内固定治疗胸腰椎骨折创伤小、出血少、恢复快,骨折撑开复位效果满意。Objective To design a new extracorporeal reduction device for percutaneous pedicle screw fixation of thoracolumbar fractures （short for ＂new reduction device＂）, and to evaluate its effectiveness. Methods According to the mechanism of thoracolumbar fractures and biomechanics characteristic of reduction, a new reduction device was designed and used in a combination with long U-shaped hollow pedicle screw system. Between January 2014 and January 2016, 36 patients （group A） with single segment thoracolumbar fracture without neurological complications underwent percutaneous pedicle screw fixation, and the clinical data were compared with those of another 39 patients （group B） with thoracolumbar fracture underwent traditional open pedicle screw fixation. There was no significant difference in gender, age, cause of injury, classification of fractures, segments of fractures, injury to operation interval, height percentage of injury vertebrae, and kyphotic angle between 2 groups （P〉0.05）. The 2 groups were compared in terms of operation time, length of incision, intraoperative blood loss, drainage volume, visual analogue scale （VAS） at postoperative 24 hours, fluoroscopy frequency, ambulation time, height percentage of injury vertebrae, kyphotic angle and correction. Results GroupA was significantly better than group B in the operation time, length of incision, intraoperative blood loss, aralnag~ volume, VAS score at postoperative 24 hours, and ambulation time （P〈0.05）. However, fluoroscopy frequency of group B was significantly less than that of group A （P〈0.05）. All patients were followed up 11.2 months on average （range, 7-15 months）. There was no intraoperative and postoperative complications of iatrogenic nerve injury, infection, breakage of internal fixation. Mild pulling-out of pedicle screws occurred in 1 case of group A during operation. The kyphotic angle and height percentage of the fractured vertebral body were significantly improved at 3 days after operation when comp

关 键 词：胸腰椎骨折 微创性 骨折复位 内固定 新型撑开器 

分 类 号：R687.3[医药卫生—骨科学]