椎旁肌间隙入路与后正中入路椎弓根螺钉内固定结合伤椎置钉治疗胸腰椎段脊柱骨折的疗效对比  

Comparison of the therapeutic effect of paravertebral space approach and posterior pedicle screw internal fixation combined with pedicle screw fixation in the treatment of thoracolumbar spine fracture

作　　者：李代君[1] 蔡小军[1] 董革辉[1] 韩建华[1] 周鑫[1] Li Daijun;Cai Xiaojun;Dong Gehui;Han Jianhua;Zhou Xin(Second Department of Orthopedics, the First People＇s Hospital of ZunYi City, Zunyi 563000, Guizhou, Chin)

机构地区：[1]贵州省遵义市第一人民医院骨二科,贵州遵义563000

出　　处：《辽宁医学杂志》2018年第3期24-27,共4页Medical Journal of Liaoning

摘　　要：目的对比两种入路方式在胸腰椎段脊柱骨折椎患者弓根螺钉内固定结合伤椎置钉手术中的应用价值。方法选取2015年2月~2017年1月收治的胸腰椎段脊柱骨折患者94例为研究对象,以随机数字表法分为A组47例,B组47例,两组均行弓根螺钉内固定结合伤椎置钉手术治疗,A组选择椎旁肌间隙入路,B组选择后正中入路椎,观察两组患者手术及术后恢复相关指标,手术前后IVW、Cobb's角、ODI评分、VAS评分及术后并发症发生情况。结果 A组手术时间、术后住院时间同B组比较,明显较短,术中出血量、术后引流量同B组比较,明显较少,差异有统计学意义(P<0.05);两组术前IVW、Cobb's角、ODI评分、VAS评分无统计学差异(P>0.05),术后均有改善,A组术后1年ODI评分、VAS评分与B组比较,明显较低,差异有统计学意义(P<0.05),两组IVW、Cobb's角无统计学差异(P>0.05);A组术后并发症发生率为2.13%,B组为4.26%,两组差异无统计学意义(P>0.05)。结论与后正中入路相比,椎旁肌间隙入路在椎弓根螺钉内固定结合伤椎置钉术中应用,可缩短手术时间,减少术中损伤,促进术后恢复,且能更有效改善脊柱稳定性,减轻疼痛,具有更高应用价值。Objective To compare the value of two approaches in the operation of the thoracolumbar spine fracture vertebra with the pedicle screw fixation combined with wound screw fixation. Methods A total of 94 patients with thoracolumbar vertebral fracture who were admitted to our hospital from Feb 2015 to Jan 2017 were selected as the research subjects.They were randomly divided into A group with 47 cases and B group with 47 cases. The two groups were treated with pedicle screw fixation combined with wound screw fixation. Group A selected paravertebral space approach,and group B selected the posterior entrances. To observe the related indexes of operation and postoperative recovery,the IVW,Cobb＇ s angle,ODI score,VAS score before and after operation and postoperative complications in two groups. Results The operation time and the postoperative hospital time in the A group were significantly shorter than those in the B group. The amount of intraoperative bleeding and the postoperative flow rate of A group were less than those in the group B,the difference was statistically significant（ P 〈 0. 05）. There was no significant difference in the IVW,Cobb＇ s angle,ODI score,and VAS score between the two groups before operation（ P 〉 0. 05）,and all of them were improved after operation. In group A,the ODI score and VAS score were significantly lower than group B at 1 year after operation,the difference was statistically significant（ P〈 0. 05）,There was no significant difference between the two groups of IVW and Cobb＇s angles（ P 〉 0. 05）.. The incidence of postoperative complications was 2. 13% in group A and 4. 26% in group B. There was no statistically significant difference between the two groups（ P〉0. 05）. Conclusion Compared with posterior entrances,paraspinal approach in pedicle screw fixation combined with wound screw fixation,can shorten the operation time,reduce intraoperative injury,promote postoperative recovery,and can effectively improve the stability of the spine,relieve pain,has hi

关 键 词：胸腰椎骨折 椎弓根螺钉内固定 伤椎置钉 入路 

分 类 号：R687.3[医药卫生—骨科学]