经肌间隙不同运动单元固定治疗A1型胸腰椎骨折的临床疗效对比  

Comparison of transmuscular space pedicle screw internal fixation with different exercise units in treatment of type A1 thoracolumbar fracture

作　　者：焦鹏增 赵志峻 杨文丽 文庆信 于文浩[1] JIAO Peng-zeng;ZHAO Zhi-jun;YANG Wen-li;WEN Qing-xin;YU Wen-hao(Department of Orthopaedics,East District,First Hospital of Handan,Handan Hebei 056001,China)

机构地区：[1]邯郸市第一医院东区骨科,河北邯郸056001

出　　处：《局解手术学杂志》2020年第10期840-843,共4页Journal of Regional Anatomy and Operative Surgery

基　　金：河北省医学科学研究重点课题计划项目(20150851)。

摘　　要：目的对比经肌间隙不同运动单元固定治疗A1型胸腰椎骨折的临床疗效。方法选择2015年1月至2018年12月我院收治的84例A1型胸腰椎骨折患者为研究对象,将其以随机数字表法分为单运动单元组和双运动单元组。双运动单元组实施经肌间隙双运动单元椎弓根钉内固定治疗,单运动单元组则实施经肌间隙单运动单元椎弓根钉内固定治疗。比较2组临床疗效、手术时间、术中失血量、手术前后疼痛情况及术后并发症发生情况。结果单运动单元组与双运动单元组术后7 d、术后1年的ODI、伤椎前缘高度比值以及伤椎Cobb角相较于术前均有显著改善(P<0.05);单运动单元组术后7 d、术后1年的ODI低于双运动单元组(P<0.05),而伤椎前缘高度比值、伤椎Cobb角与双运动单元组相比,差异无统计学意义(P>0.05)。单运动单元组术中失血量及手术时间少/短于双运动单元组,差异均有统计学意义(P<0.05)。单运动单元组与双运动单元组术后7 d、术后6个月及术后1年的VAS评分均低于术前,且单运动单元组术后7 d的VAS评分低于双运动单元组(P<0.05),而2组术前、术后6个月以及术后1年的VAS评分相比,差异无统计学意义(P>0.05)。术后神经损伤、切口皮缘发黑以及关节退变等并发症发生率组间比较,差异无统计学意义(P>0.05)。结论与双运动单元椎弓根钉内固定治疗相比,经肌间隙单运动单元椎弓根钉内固定治疗A1型胸腰椎骨折的临床疗效更佳,可减少患者术中创伤,且不会增加并发症发生率。Objective To compare the clinical effect of transmuscular space pedicle screw internal fixation with different exercise units in the treatment of type A1 thoracolumbar fracture.Methods A total of 84 patients with type A1 thoracolumbar fracture who were admitted to our hospital from January 2015 to December 2018 were included in the study,and they were divided into single unit group and double units group by random number table method.The double units group was treated by transmuscular space pedicle screw internal fixation with two units,while the single unit group was treated by transmuscular space pedicle screw internal fixation with single unit.The two groups were compared in terms of clinical efficacy,operative time,intraoperative blood loss,pain before and after surgery and postoperative complications.Results The ODI,anterior height ratio of injured vertebrae and Cobb angle of injured vertebrae in both of the two groups were significantly improved 7 days and 1 year after surgery(P<0.05).The ODI in the single unit group were lower than those in the double units group 7 days and 1 year after surgery(P<0.05).However,there was no significant difference in the anterior height ratio of injured vertebrae and Cobb angle of injured vertebrae between the two groups(P>0.05).The intraoperative blood loss and operative time of single unit group were less/shorter than those of double units group,the differences were signifianct(P<0.05).VAS scores of the two groups 7 days,6 months and 1 year after surgery were lower than those before surgery,and VAS score of the single unit group was lower than that of the double units group 7 days after surgery(P<0.05),but no significant difference was found in VAS score between the two groups before surgery,6 months and 1 year after surgery(P>0.05).There was no significant difference between the two groups in the incidence of postoperative nerve injury,blackening of incision skin margin and joint degeneration(P>0.05).Conclusion Compared with transmuscular space pedicle screw internal fixa

关 键 词：胸腰椎骨折 运动单元 椎弓根钉 经肌间隙入路 

分 类 号：R683.1[医药卫生—骨科学] R683.2[医药卫生—外科学]