不同入路椎弓根钉治疗胸腰椎段脊柱骨折的临床效果比较  

Comparison of clinical effects of different approaches of pedicle nail in the treatment of thoracolumbar spine fractures

作　　者：张宝强[1] 郭峰 张小栋[1] 张婷[1] 孙杨 熊咏民[3] ZHANG Baoqiang;GUO Feng;ZHANG Xiaodong;ZHANG Ting;SUN Yang;XIONG Yongmin(Affiliated Hospital of Hanzhong Vocational and Technical College,Hanzhong 723000;Xianyang Hospital of Yan'an University,Xianyang 712000;Xi'an Jiaotong University,Xi'an 710049,China)

机构地区：[1]汉中职业技术学院附属医院,陕西汉中723000 [2]延安大学咸阳医院,陕西咸阳712000 [3]西安交通大学,陕西西安710049

出　　处：《临床医学研究与实践》2022年第17期51-54,共4页Clinical Research and Practice

基　　金：国家自然科学基金(No.8157120939)。

摘　　要：目的比较不同入路椎弓根钉治疗胸腰椎段脊柱骨折的临床效果。方法选取2017年1月至2019年12月我院接收的90例无神经损伤胸腰椎段脊柱骨折患者作为研究对象,以入院编号的奇偶性将其分为试验组与参照组,各45例。试验组实施经皮椎弓根钉微创手术,参照组实施Wiltse入路椎弓根钉内固定术。比较两组的影像学指标(椎体前缘相对高度、脊椎间隙高度、脊柱后凸Cobb角、矫正丢失度)、日常生活能力、胸腰椎功能、疼痛程度、复位情况、炎症因子水平及手术相关指标。结果术后1年,参照组的矫正丢失度、复位率高于试验组(P<0.05)。术后4周、1年,试验组的Barthel指数评分高于参照组,ODI评分低于参照组(P<0.05);术后4周,试验组的VAS评分低于参照组(P<0.05)。术后4周,参照组的CRP、TNF-α、IL-6水平高于试验组,IL-10水平低于试验组(P<0.05)。参照组的手术时间短于试验组,术中出血量多于试验组,术中透视次数少于试验组,手术切口长度长于试验组(P<0.05)。结论Wiltse入路与经皮入路椎弓钉治疗无神经损伤胸腰椎段脊柱骨折的远期恢复效果均较为理想,但经皮入路的近期效果更为理想。Objective To compare the clinical effects of different approaches of pedicle nail in the treatment of thoracolumbar spinal fractures.Methods A total of 90 patients with thoracolumbar spinal fractures without nerve injury received in our hospital from January 2017 to December 2019 were selected as the research objects.The patients were divided into experimental group and reference group according to the parity of admission number,with 45 cases in each group.The experimental group was treated with percutaneous pedicle screw minimally invasive surgery,and the reference group was treated with Wiltse approach pedicle screw internal fixation.The imaging indexes(relative height of anterior vertebral body,height of intervertebral space,Cobb angle of kyphosis,degree of correction loss),ability of daily living,thoracolumbar function,pain degree,reduction,inflammatory factors levels and operation related indexes were compared between the two groups.Results One year after operation,the degree of correction loss and reduction rate in the reference group were higher than those in the experimental group(P<0.05).At 4 weeks and 1 year after operation,the Barthel index score of the experimental group was higher than that of the reference group,while the ODI score was lower than that of the reference group(P<0.05);at 4 weeks after operation,the VAS score of the experimental group was lower than that of the reference group(P<0.05).At 4 weeks after operation,the levels of CRP,TNF-αand IL-6 in the reference group were higher than those in the experimental group,while the level of IL-10 was lower than that in the experimental group(P<0.05).The operation time of the reference group was shorter than that of the experimental group,the intraoperative bleeding volume was more than that of the experimental group,the number of intraoperative fluoroscopy was less than that of the experimental group,and the length of surgical incision was longer than that of the experimental group(P<0.05).Conclusion The long-term recovery effects of Wiltse app

关 键 词：胸腰椎段脊柱骨折 经皮椎弓根钉微创手术 Wiltse入路椎弓根钉内固定术 

分 类 号：R687.3[医药卫生—骨科学]