单纯后路短节段经皮椎弓根螺钉内固定治疗A3型和A4型胸腰段骨折的临床疗效  

Clinical Efficacy of Short Posterior Segmental Percutaneous Pedicle Screw Fixation for the Treatment of A3 and A4 Thoracolumbar Fractures

作　　者：陈在飞[1,2] 梁正忠[1,2] 夏瑞涛[1,2] 肖劲松[1,2] 张志跃[1,2] CHEN Zai-fei;LIANG Zheng-zhong;XIA Rui-tao;XIAO Jin-song;ZHANG Zhi-yue(Department of Bone,Section One,the Fifth Affiliated Hospital of Kunming Medical University,Kunming,Yunnan Province,650000 China;Department of Bone,Section One,Yunnan Kunming Medical University (Gejiu People's Hospital,Gejiu,Yunnan Province,661000 China)

机构地区：[1]云南省昆明医科大学第五附属医院骨一科,云南昆明650000 [2]云南昆明医科大学(云南省红河州个旧市人民医院骨一科),云南个旧661000

出　　处：《中外医疗》2019年第5期16-18,共3页China & Foreign Medical Treatment

基　　金：云南省教育厅科学研究基金指导性项目(100210)

摘　　要：目的探讨针对A3型或A4型胸腰段骨折患者以单纯后路短节段经皮椎弓根螺钉内固定术治疗的临床疗效。方法方便选择该院2017年1—12月期间诊治的A3型或A4型胸腰段骨折患者80例作为研究样本,以随机抽样法分组为观察组和对照组。观察组的40例患者均采取单纯后路短节段经皮椎弓根螺钉内固定术治疗方案,对照组的40患者均采取后路经肌间隙短节段联合伤椎弓根螺钉内固定。比较两组患者的术中切口长度、手术耗时和术中平均出血量术后切口的疼痛度。结果观察组患者的术中切口长度(9.21±1.34)cm,对照组(10.92±2.05)cm(t=4.217,P=0.000);观察组手术耗时(90.26±11.35)min,对照组(121.46±5.86)min (t=4.638,P=0.000);观察组术中平均出血量(50.72±14.59)mL,对照组(151.46±19.68)mL (t=5.034,P=0.000);术后切口疼痛评分等均显著优于对照组患者(P<0.05)。且两组患者手术后都未出现并发症,两组患者手术之后都获得了满意骨折愈合效果。术毕即刻两组患者伤椎前缘高度以及矢状面的Cobb角较术前均得以显著纠正,两组患者末次随访伤椎前缘高度及Cobb角同术后即刻相比都未出现明显丢失,差异无统计学意义(P>0.05)。结论在A3型或者A4型胸腰段骨折患者的治疗中采取单纯后路短节段经皮椎弓根螺钉内固定治疗方案,有利于降低患者术中出血量并缓解术后疼痛,该治疗方案效果较优。Objective To investigate the clinical efficacy of short posterior segmental percutaneous pedicle screw fixation for patients with A3 or A4 thoracolumbar fractures.Methods 80 patients with A3 or A4 thoracolumbar fractures from January to December 2017 were convenient selected as the study samples.The patients were randomly divided into observation group and control group.All the 40 patients in the observation group underwent simple posterior short-segment percutaneous pedicle screw fixation.40 patients in the control group underwent posterior transforaminal short-segment combined with pedicle screw fixation.The intraoperative incision length,the time of surgery,and the mean intraoperative blood loss were compared between the two groups.Results The length of intraoperative incision in the observation group was(9.21±1.34)cm,in the control group(10.92±2.05)cm(t=4.217,P=0.000).The operation time of the observation group was(90.26±11.35)min,and the control group(121.46±5.86)min(t=4.638,P=0.000);the average blood loss(50.72±14.59)mL in the observation group and the control group(151.46±19.68)mL(t=5.034,P=0.000);postoperative incision pain scores were significantly better than those in the control group(P<0.05).There were no complications after operation in both groups,and both groups achieved satisfactory fracture healing after surgery.At the end of the operation,the Cobb angle of the anterior height of the injured vertebrae and the sagittal plane were significantly corrected before surgery.The height of the anterior edge of the injured vertebrae and the Cobb angle of the two groups were not significantly lost compared with the immediate postoperatively.The difference was not significant(P>0.05).Conclusion The treatment of patients with A3 or A4 thoracolumbar fractures with simple posterior short-segment percutaneous pedicle screw fixation is beneficial to reduce the amount of intraoperative blood loss and relieve postoperative pain.The effect is better.

关 键 词：胸腰段骨折 单纯后路短节段 椎弓根螺钉内固定 疗效 

分 类 号：R687.3[医药卫生—骨科学]