一期后路椎管减压联合短节段内固定治疗胸腰段不稳定性爆裂骨折  

One-stage posterior spinal canal decompression combined with short-segment internal fixation in the treatment of unstable burst fracture of thoracolumbar segment

作　　者：吴永贵 李晋惠 牛宇飞 秦海江 WU Yong-gui;LI Jin-hui;NIU Yu-fei;QIN Hai-jiang(Second Ward of Orthopedics Department,Jincheng People’s Hospital,Jincheng Shanxi 048000,China)

机构地区：[1]晋城市人民医院骨科二病区,山西晋城048000

出　　处：《局解手术学杂志》2022年第7期609-614,共6页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的探究一期后路椎管减压联合短节段内固定治疗胸腰段不稳定性爆裂骨折的效果。方法回顾性选择于我院行一期后路椎管减压联合短节段内固定治疗的60例胸腰段不稳定性爆裂骨折患者作为观察组,另选60例行单纯短节段内固定治疗的胸腰段不稳定性爆裂骨折患者作为对照组。比较2组患者的手术相关指标;比较2组患者术前、术后即刻、术后6个月的影像学指标及疗效评估指标;采用随机行走模型评价2组患者影像学指标及疗效评估指标的改善情况;比较2组患者并发症发生情况。结果2组患者椎弓根螺钉置入总数均为360枚,2组置钉准确率比较差异无统计学意义(P>0.05);观察组患者的手术时间明显长于对照组(P<0.05);2组患者的术中出血量、术后引流量、住院时间比较差异无统计学意义(P>0.05)。2组患者术前、术后即刻、术后6个月的伤椎中柱高度依次升高,伤椎骨块侵入面积、伤椎椎管侵占率、节段后凸角、疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)均依次降低,不同时间点间的差异均具有统计学意义(P<0.05);2组患者术前及术后6个月的影像学指标及疗效评估指标比较差异无统计学意义(P>0.05),观察组患者术后即刻的影像学指标及疗效评估指标改善情况明显优于对照组(P<0.05)。随机行走模型评价结果显示,观察组患者影像学指标及疗效评估指标的改善情况优于对照组。2组患者术中、术后及随访期间均未出现严重并发症。结论一期后路椎管减压联合短节段内固定能够有效减压,恢复胸腰段不稳定性爆裂骨折患者的伤椎中柱高度和伤椎节段后凸角,减轻患者疼痛程度,有利于患者术后恢复,临床疗效较好,且安全性较高。Objective To explore the effect of one-stage posterior spinal canal decompression combined with short-segment internal fixation in the treatment of unstable burst fracture of thoracolumbar segment.Methods A total of 60 patients with unstable burst fracture of thoracolumbar segment treated with one-stage posterior spinal canal decompression combined with short-segment internal fixation in our hospital were retrospectively selected as the observation group,and another 60 patients with unstable burst fracture of thoracolumbar segment treated with simple short-segment internal fixation were selected as the control group.The operation-related indexes of the two groups were compared,and the imaging indexes and efficacy evaluation indexes before operation,immediately after operation and 6 months after operation of the two groups were compared.The improvement of imaging indexes and efficacy evaluation indexes of the two groups were evaluated by random walk model.The complications of the two groups were compared.Results The total number of pedicle screws placed in the two groups was 360,and there was no statistically significant difference in the accuracy of screw placement between the two groups(P>0.05).The operation time in the observation group was significantly longer than that in the control group(P<0.05).There was no statistically significant difference in the intraoperative blood loss,postoperative drainage volume or hospital stay between the two groups(P>0.05).The heights of central column of the injured vertebrae in the two groups increased in sequence,while the bone invasion area of the injured vertebrae,the invasion rate of the injured spinal canal,the segmental kyphosis angle,the pain visual analogue scale(VAS)score and the Oswestry disability index(ODI)decreased in sequence before operation,immediately after operation and 6 months after operation(P<0.05),and the differences at different time points were statistically significant(P<0.05).There was no statistically significant difference in the imaging indexes

关 键 词：一期后路椎管减压 短节段内固定 胸腰段不稳定性爆裂骨折 随机行走模型 

分 类 号：R683.2[医药卫生—骨科学]