微创经皮与传统切开椎弓根钉内固定治疗AO-A型无神经损伤胸腰椎骨折的临床疗效观察  

Clinical efficacy of percutaneous pedicle screw fixation and conventional open reduction and internal fixation for the treatment of AO-A type thoracolumbar fractures without nerve injuries

作　　者：张彤童 任龙喜[1] 郭函[1] 刘正[1] ZHANG Tongtong;REN Longxi;GUO Han;LIU Zheng(Department of Orthopedics,Beijing Chuiyangliu Hospital Affiliated to Tsinghua University,Beijing 100022,China)

机构地区：[1]清华大学附属北京市垂杨柳医院骨科,100022

出　　处：《疑难病杂志》2018年第6期602-605,共4页Chinese Journal of Difficult and Complicated Cases

基　　金：卫生部医药卫生科技发展研究中心科研课题(W2013ZT039)

摘　　要：目的 对比微创经皮椎弓根钉内固定与传统切开复位内固定治疗AO-A型无神经损伤胸腰椎骨折的疗效。方法选择2014年12月—2016年12月于北京市垂杨柳医院骨科治疗的72例AO-A型无神经损伤胸腰椎骨折患者,并采用随机数字表法分为2组,其中观察组(36例)采用微创经皮椎弓根钉内固定治疗,对照组(36例)采用传统切开复位椎弓根钉内固定治疗。对比2组围术期指标(手术时间、术中出血量、切口长度、住院时间)、影像学指标(椎前缘高度、后凹Cobb角、矢状指数)以及术后VAS评分、ODI指数。结果观察组术中出血量为(100.82±23.53)ml,切口长度为(61.92±8.93)mm,住院时间为(9.12±2.03)d,均显著优于对照组的(309.28±35.67)ml、(128.83±13.02)mm、(14.83±3.18)d(t=8.738、9.928、6.048,P<0.01);术后2组伤椎前缘高度、后凸Cobb角、矢状位指数均较术前均明显改善(P<0.01),但2组间比较差异无统计学意义(P>0.05);术后2组VAS评分、ODI指数均显著低于术前,且观察组术后显著低于对照组(t=7.920、8.938,P<0.01)结论采用微创经皮椎弓根钉内固定能够有效治疗AO-A型无神经损伤胸腰椎骨折,在控制术中创伤、术后疼痛感及术后恢复等方面明显优于传统切开复位内固定术,临床应用价值较高。Objective To investigate and compare the efficacy of percutaneous pedicle screw fixation and conventional open reduction and internal fixation in the treatment of AO-A type thoracolumbar frac tures without nerve injuries. Methods Seventy-two cases of AO-A type thoracolumbar fractures without nerve injuries were treated in our hospital from December2014 to December 2016. The patients were randomly divided into two groups, the observation group（36 cases） treated with minimally invasive percutaneous pedicle screw fixation, the control group（36 cases） treated with open reduction and pedicle nail internal fixation. The perioperative indexes, imaging parameters, postoperative VAS score and ODI index were compared between the two groups. Results The bleeding volume in the observation group was（ 100. 82 ± 23. 53） ml, the incision length was（61.92 ±8.93） mm, the hospitalization time was（9. 12 ± 2.03） d, which were significantly lower than that in the control group（309.28 ± 35.67） ml,（128.83 ± 13.02）mm,（14.83±3.18）d（t =8.238,P〈0.05） respectively.The postoperative vertebral height, kyphosis, cobb angle, and sagittal index were better than those of before surgery in both of the two groups. The therapeutic effect in both group were significantly improved than before（P〈0.05）; postoperative VAS score and ODI index were significantly lower than before surgery, and the observation group was significantly lower than the control group（t =7.254, P〈0. 05）. Conclusion It demonstrated that the minimally invasive percutaneous pedicle screw internal fixation can effectively treat AO-A non-neurogenic thoracolumbar fractures, and is superior to traditional open reduction in controlling intraoperative trauma, postoperative pain and postoperative recovery internal fixation.

关 键 词：经皮椎弓根钉内固定 传统切开复位内固定 AO-A型无神经损伤胸腰椎骨折 疗效评价 

分 类 号：R687.3[医药卫生—骨科学]