三种不同入路手术治疗胸腰椎骨折的疗效比较  

Comparison of the Efficacy of Three Different Approaches in Treating Thoracolumbar Fractures

作　　者：孟莉[1] 孙育良 万趸[1] 梁佳佳[1] 刘俊[1] MENG Li;SUN Yuliang;WAN Dun(Sichuan Orthopaedic Hospital,Sichuan Chengdu 610041,China)

机构地区：[1]四川省骨科医院,四川成都610041

出　　处：《河北医学》2023年第4期566-572,共7页Hebei Medicine

基　　金：四川省医学会医学科研课题,(编号:S18078)。

摘　　要：目的:探究三种不同入路手术治疗胸腰椎骨折的疗效。方法:回顾性分析本院于2020年1月至2021年1月收治的325例胸腰椎骨折患者临床资料,分别将行后正中入路、经皮入路、椎旁肌间隙入路椎弓根钉棒系统内固定治疗的患者纳入A组(n=110)、B组(n=108)、C组(n=107),比较三组患者临床疗效、围术期指标、伤椎指标以及预后情况。结果:术后3个月三组VAS评分、ODI评分均降低,对三组患者术前及术后3个月的差值变化进行比较,B组、C组变化幅度大于A组且C组变化幅度大于B组,三组VAS评分、ODI评分变化幅度差异有统计学意义(P<0.05);B组、C组手术时间、术中出血量、住院时间以及骨折愈合时间均少于对照组;B组切口长度短于A组、C组(P<0.05);三组术后3个月伤椎后凸Cobb角均下降、伤椎前缘高度均上升,对三组患者术前及术后3个月的差值变化进行比较,B组、C组变化幅度大于A组且C组变化幅度大于B组,三组伤椎后凸Cobb角、伤椎前缘高度变化幅度差异有统计学意义(P<0.05);三组三维运动范围比较差异无统计学意义(P>0.05);三组患者均出现切口感染、术后残留腰背痛等并发症,三组发生率比较差异无统计学意义(P>0.05)。结论:三种手术方式预后效果佳均可在一定程度上改善脊柱运动但经皮入路与经椎旁肌间隙入路对胸腰椎骨折患者疗效、围术期指标与伤椎指标水平改善更显著,但临床上对于手术方式的选择应具有针对性以提升治疗效益。Objective:To investigate the efficacy of three different approaches in the treatment of thoracolumbar fractures.Methods:The clinical data of 325 patients with thoracolumbar fractures admitted to our hospital from January 2020 to January 2021 were retrospectively analyzed.The patients treated with the posterior median approach,percutaneous approach,and paravertebral interbody approach with the pedicle nail rod system were included in groups A(n=110),B(n=108),and C(n=107),respectively,and the clinical efficacy,perioperative indexes,injured spine indexes,and prognosis of the patients in the three groups were compared.The clinical outcomes,perioperative indexes,injured spine indexes and prognosis of the three groups were compared.Results:VAS scores and ODI scores decreased in all three groups at 3 months after surgery,and the difference between the preoperative and postoperative values of patients in the three groups were compared,and the changes in groups B and C were greater than those in group A and the changes in group C were greater than those in group B.The differences in the changes in VAS scores and ODI scores in the three groups were statistically significant(P<0.05);the difference in operating time,intraoperative bleeding,hospitalization time and fracture healing time was less in groups B and C than in the control group;the incision length was shorter in group B than in groups A and C(P<0.05);the posterior convexity Cobb's angle decreased and the height of the anterior border of the injured spine increased in all three groups at 3 months after surgery.Comparing the changes in the difference between the three groups of patients before and 3 months after surgery,the changes in groups B and C were greater than those in group A and the changes in group C were greater than those in group B.There were statistically significant differences in the magnitude of changes in the posterior convex Cobb angle and the height of the anterior edge of the injured spine in the three groups(P<0.05);there were no statistically s

关 键 词：胸腰椎骨折 椎弓根钉 内固定 

分 类 号：R687.3[医药卫生—骨科学]