经皮微创单轴椎弓根螺钉内固定治疗胸腰椎骨折的短期疗效  

Short-term efficacy of precutaneous minimally invasive monoaxial pedicle screw fixation in thoracolumbar fractures

作　　者：韩建邦[1] 俞胜宝[1] 汪颖峰[1] HAN Jianbang;YU Shengbao;WANG Yingfeng(Department of Spine Surgery,Huangshan People’s Hospital,Huangshan,Anhui 245000,China)

机构地区：[1]黄山市人民医院脊柱外科

出　　处：《安徽医药》2019年第12期2436-2439,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨经皮微创单轴椎弓根螺钉内固定治疗胸腰椎骨折的短期临床疗效。方法回顾性分析2016年7月至2018年5月黄山市人民医院41例无神经损伤症状的单节段胸腰椎骨折病人,按术式分为经皮微创单轴椎弓根螺钉固定组20例(微创组),后路开放性经肌间隙椎弓根螺钉固定21例(开放组)。对两组切口长度、手术时间、术中出血量、住院天数、视觉模拟评分法(VAS)评分、Oswestry功能障碍指数(ODI)、伤椎前缘高度比值、Cobb角等指标进行分析。结果微创组切口长度(4.6±0.4)cm、术中出血量(40.5±15.5)mL、住院天数(8.5±1.5)d均少于开放组[(10.2±1.2)cm、(84.6±29.0)mL、(13.6±3.4)d](P=0.000)。微创组术后1周VAS评分(2.3±1.4)分和ODI(22.2±8.4)%均优于开放组[(3.7±1.6)分、(33.7±13.4)%](P=0.039,0.001)。两组病人术后伤椎椎体前缘高度比值及Cobb角均较术前改善(P=0.000),术后椎体前缘高度及Cobb角无明显丢失。置钉及复位过程顺利,两组均未出现神经损伤、固定失效等并发症。结论经皮微创单轴椎弓根螺钉内固定治疗胸腰椎骨折疗效确切,骨折复位满意、固定牢靠,与传统后路开放性经肌间隙椎弓根螺钉固定术相比创伤小、出血少、恢复快。Objective To compare the short term clinical efficacy between minimally invasive percutaneous monoaxial pedicle screw fixation with traditional open pedicle screw fixation in the treatment of thoracolumbar fracture.Methods 41 patients with single segmental thoracolumbar fractures without neurological symptoms were divided into two groups according to treatment meth ods.Group A:21 patients treated with minimally invasive percutaneous monoaxial pedicle screw fixation;Group B:20 patients treat ed with traditional open pedicle screw fixation.The incision length,operation time,blood loss during operation,length of hospital stay,VAS,ODI,height of injured vertebral and sagittal Cobb angle were compared between two groups.Results The incision length(4.6±0.4)cm,blood loss during operation(40.5±15.5)mL,length of hospital stay(8.5±1.5)d were less in group A than those in group B[(10.2±1.2)cm,(84.6±29.0)mL,(13.6±3.4)d](P=0.000).Group A had lower VAS(2.3±1.4)and ODI(22.2±8.4)%scores on one week postoperation[(3.7±1.6)and(33.7±13.4)%](P=0.039,0.001).There were improvements in Cobb an gle and anterior height in two groups(P=0.000).The fracture vertebral front height and Cobb angle had no significantly loss at fi nal follow up than the immediate postoperation.there were no neurological injuries or internal fixation failure in both two groups,and no difficulty about fracture reduction or placement of pedicle screws.Conclusion Compared with the traditional open surgery,the percutaneous minimally invasive monoaxial pedicle screw fixation can achieve good efficacy in the treatment of thoracolumbar fractures,with less lesion、less intraoperative blood loss and quicker recovery.

关 键 词：脊柱骨折 胸椎 腰椎 骨钉 骨折固定术 内 外科手术 微创性 

分 类 号：R68[医药卫生—骨科学]