椎弓根内固定术式不同入路治疗未合并神经损伤胸腰段椎体爆裂性骨折对比观察  

Contrast observation of different approach for the treatment of thoracolumbar vertebral body burst fractures without neurological damage

作　　者：李再学 谢文伟 冉雪莲 姚汉刚 苏厂尧 

机构地区：[1]东莞市第三人民医院,广东523000

出　　处：《创伤外科杂志》2017年第4期258-261,共4页Journal of Traumatic Surgery

摘　　要：目的探讨常规与改良后正中切口入路椎弓根内固定术式治疗未合并神经损伤的胸腰椎爆裂性骨折临床效果。方法东莞市第三人民医院2010年3月~2014年7月收治的未合并神经损伤的胸腰椎爆裂性骨折患者110例,按不同入路分为后正中切口常规开放组(常规组,55例)和改良肌间隙入路行椎弓根内固定组(改良组,55例)。比较两组手术时间、术中出血量、术后引流量、术后下地时间,手术前后VAS评分、椎体前后缘高度比、Cobb角以及术后随访JOA评分、术后并发症发生率。结果改良组手术时间、术中出血量、术后引流量、术后下地时间分别为(52.25±8.84)min、(127.47±22.13)m L、(38.15±4.52)m L、(5.81±1.44)d,均优于常规组的(74.47±10.19)min、(231.14±37.96)m L、(92.37±10.25)m L、(11.26±2.60)d,且该两组术后7d,6、12个月VAS评分分别为(5.96±1.18)、(1.26±0.27)、(1.13±0.20)分,均低于常规组的(6.85±1.56)、(1.95±0.46)、(1.74±0.37)分(P<0.05);改良组术后椎体前后缘高度比为(87.33±15.20)%、(91.74±6.86)%,Cobb角为(2.26±0.52)°,JOA评分为(25.38±3.77),均显著优于常规组的(81.50±5.72)%、(94.20±7.09)%、(5.47±1.30)°、(22.15±3.40),改良组患者切口感染和切口裂开发生率低于常规组(P<0.05)。结论相较于常规后正中切口入路椎弓根内固定术式,改良后正中切口入路椎弓根内固定术式治疗未合并神经损伤的胸腰椎爆裂性骨折更具优势。Objective To investigate the clinical effect of conventional and modified posterior incision approach with pedicle screw fixation for thoracolumbar burst fractures without neurological damage.Methods A total of 110 patients with thoracolumbar burst fractures were enrolled in our hospital from Mar.2010 to Jul.2014.The patients were divided into the conventional group（55 cases） and the modified group（55 cases）,respectively,according to the use of posterior incision conventional approach and improved muscle gap approach for pedicle screw fixation.The operation time,blood volume,drainage volume,ambulation time,VAS score,vertebral anteroposterior height ratio,Cobb angle,JOA score and incidence of postoperative complications were compared between the two groups.Results The operation time,blood volume,drainage volume and ambulation time of the modified group was（52.25 ± 8.84） min,（127.47 ± 22.13） m L,（38.15 ± 4.52） m L,（5.81 ± 1.44） d respectively,better than those in the conventional group[（74.47 ± 10.19） min,（231.14 ± 37.96） m L,（92.37 ± 10.25） m L,（11.26 ± 2.60） d].The VAS score of the modified group before sugery,7 days,6 months and 12 months after surgery was（5.26 ±1.02）,（5.96 ± 1.18）,（1.26 ± 0.27） and（1.13 ± 0.20） respectively,significantly lower than those of the conventional group[（5.35 ± 1.06）,（6.85 ± 1.56）,（1.95 ± 0.46）,（1.74 ± 0.37）,P〈0.05].The posterior margin height ratio,Cobb＇s angle and JOA score of the modified group were（87.33 ± 15.20） %,（91.74 ± 6.86） %,（2.26± 0.52） °and（25.38 ± 3.77） respectively,significantly better than those of the conventional group [（81.50 ±5.72） %,（94.20 ± 7.09） %,（5.47 ± 1.30） °,（22.15 ± 3.40） ].The incidence of incisional infection and incisional dehiscence was significantly lower in the modified group than in the conventional group（P〈0.05）.Conclusion Compared with conventional posterior incision approach for pedicle screw fixation,modifie

关 键 词：胸腰椎骨折 椎弓根 内固定 入路 

分 类 号：R687.3[医药卫生—骨科学]