经皮椎弓根钉棒跨伤椎内固定治疗胸腰椎骨折的临床研究  

Clinical study of percutaneous transpedicular screw-rod internal fixation for thoracolumbar fracture

作　　者：梁鸿志[1] 周立[1] 姚树俊[1] 刘照树[1] 张潇[1] 赵晗程 LIANG Hong-zhi;ZHOU Li;YAO Shu-jun;LIU Zhao-shu;ZHANG Xiao;ZHAO Han-cheng(Department of Osteoarthroplasty,Zhoukou Central Hospital,Zhoukou,Henan 466000,China)

机构地区：[1]周口市中心医院骨关节外科

出　　处：《创伤外科杂志》2020年第2期108-112,共5页Journal of Traumatic Surgery

基　　金：河南省科技发展计划项目(142300410193)

摘　　要：目的探讨经皮椎弓根钉棒跨伤椎内固定治疗胸腰椎骨折的临床效果。方法回顾性分析2015年3月-2018年1月周口市中心医院骨关节外科收治的99例胸腰椎骨折患者的临床资料,男性54例,女性45例;年龄24~63岁,平均41.0岁;致伤原因:高处坠落伤25例,摔伤37例,道路交通伤37例;骨折部位:T1123例、T1222例、L127例、L227例;骨折类型:压缩性骨折51例,爆裂性骨折48例。将入选的患者根据手术方式的不同分为A组(n=53,开放椎弓根钉棒系统治疗)和B组(n=46,经皮椎弓根钉棒系统治疗)。比较两组患者围术期指标、功能改善、疼痛情况、影像学指标情况,记录两组术后并发症发生率。结果 B组患者手术时间[(81.6±5.3)min vs.(102.8±4.8)min]、住院时间[(8.1±1.4)d vs.(11.1±1.9)d]短于A组,术中出血量[(52.8±4.1)mL vs.(66.6±3.1)mL]少于A组(P<0.05);B组术后1、3、12个月VAS评分均低于A组[(3.6±0.4)分vs.(4.6±0.4)分,(2.4±0.4)分vs.(3.5±0.4)分,(0.9±0.2)分vs.(1.8±0.2)分,P<0.05],Oswestry功能障碍指数(ODI)均低于A组[(25.1±3.3)分vs.(33.2±3.9)分,(16.9±2.4)分vs.(23.7±3.7)分,(9.2±1.1)分vs.(15.8±2.2)分,P<0.05]。两组患者术后即刻、术后12个月后凸Cobb角较术前下降,伤椎前缘相对高度较术前升高(P<0.05);但A、B两组术后即刻、术后12个月后凸Cobb角、伤椎前缘相对高度比较差异无统计学意义。两组并发症发生率比较差异无统计学意义(15.09%vs. 10.87%,P>0.05)。结论相对于开放椎弓根钉棒系统治疗,经皮椎弓根钉棒系统治疗胸腰椎骨折,在获得同等治疗效果的基础上,具有创伤小、术后恢复快等优势,同时还可有效改善术后疼痛及腰椎功能,不增加术后并发症发生率,临床应用价值较高。Objective To investigate the clinical effect of percutaneous transpedicular screw-rod internal fixation for thoracolumbar fractures.Methods Totally 99 patients with thoracolumbar fractures who were admitted to our hospital from Mar. 2015 to Jan. 2018 were retrospectively selected.There were 54 males and 45 females,aged from 24 to 63 years,with an average age of 41.0 years.The causes of injuries included 25 high falling,37 falls and 37 traffic accidents.The fracture sites were T11in 23 cases,T12in 22 cases,L1 in 27 cases and L2 in 27 cases. The types of fractures were compressive fractures in 51 cases and burst fractures in 48 cases.The patients were divided into group A(n=53,open pedicle screw-rod system) and group B(n=46,percutaneous pedicle screw-rod system).The perioperative indicators,functional improvement,pain and imaging indicators were compared between the two groups,and the incidence of complications was recorded.Results The operation time and hospitalization time of group B were shorter than those of group A, and the amount of bleeding during operation was less than that of group A[(81.6±5.3)min vs.(102.8±4.8)min,(8.1±1.4)d vs.(11.1±1.9)d,(52.8±4.1)mL vs.(66.6±3.1)mL, P<0.05]. The visual analogue scale[(3.6±0.4)points vs.(4.6±0.4)points,(2.4±0.4)points vs.(3.5±0.4)points,(0.9±0.2)points vs.(1.8±0.2)points,P<0.05] and Oswestry dysfunction index(ODI) in group B were lower than those in group A at 1 month, 3 months and 12 months after operation[(25.1±3.3)points vs.(33.2±3.9)points,(16.9±2.4)points vs.(23.7±3.7)points,(9.2±1.1)points vs.(15.8±2.2)points,P<0.05]. The Cobb angle decreased immediately after operation and 12 months after operation, and the relative height of the anterior edge of the injured vertebra was higher than that before operation(P<0.05), but there was no significant difference in the Cobb angle and the relative height of the anterior edge of the injured vertebra between groups A and B immediately after operation and 12 months after operation. There was no significant d

关 键 词：胸腰椎骨折 椎弓根 钉棒 内固定 

分 类 号：R683.2[医药卫生—骨科学]