[1]李驰 郭中华 原野.经皮椎弓根螺钉内固定术治疗胸腰椎骨折的临床研究[J].中国中医骨伤科杂志,2017,25(08):39-42,47.
　LI Chi GUO Zhonghua YUAN Ye.The Clinical Study of Treating Thoracolumbar Fractures with Percutaneous Pedicle Screw Internal Fixation[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2017,25(08):39-42,47.
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经皮椎弓根螺钉内固定术治疗胸腰椎骨折的临床研究()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第25卷
期数:
2017年08期
页码:
39-42,47
栏目:
临床研究
出版日期:
2017-08-03

文章信息/Info

Title:
The Clinical Study of Treating Thoracolumbar Fractures with Percutaneous Pedicle Screw Internal Fixation
文章编号:
1005-0205(2017)08-0039-05
作者:
李驰1 郭中华1 原野1
1.湖北武汉市东西湖人民医院骨科(武汉,430040)
Author(s):
LI Chi1 GUO Zhonghua1 YUAN Ye1
1.Department of Orthopaedics,Dongxihu District People's Hospital of Wuhan,Wuhan 430040,China.
关键词:
经皮椎弓根螺钉内固定术;  胸腰椎骨折;  脊柱微创
Keywords:
percutaneous pedicle screw fixation;  thoracolumbar fractures;  minimally invasive
分类号:
R683.2
文献标志码:
A
摘要:
目的:比较经皮椎弓根螺钉内固定术(PPSIF)与后路切开复位椎弓根螺钉内固定术治疗胸腰椎骨折的治疗效果,探讨PPSIF治疗胸腰椎骨折的临床价值。方法:回顾性研究2012年1月至2016年2月在本院手术治疗的资料完整的胸腰椎骨折患者共130例,将患者分为研究组(采用PPSIF治疗)和对照组(采用开放手术治疗),比较两组患者手术情况、术前、术后第5天、术后6个月的后凸Cobb角、椎体前缘高度值、Oswestry功能障碍指数评分(ODI指数)、疼痛评分(VAS)等指标,MRI检查观察手术前后手术区域炎症水肿体积。结果:两组患者的手术时间差异无统计学意义(P>0.05); 对照组术中X线检查次数低于研究组(P<0.05); 术中出血量、伤口引流量、下床时间均大于研究组(P<0.05)。两组术后后凸Cobb角及后凸Cobb角丢失比较均无统计学意义(P>0.05)。两组椎体前缘高度值比较差异均无统计学意义(P>0.05)。 对照组术后第1天,第3天的VAS高于研究组,差异有统计学意义(P<0.05),术后第5天和术后6个月对照组VAS高于研究组,差异有统计学意义(P>0.05)。两组术前ODI指数差异无统计学意义(P>0.05),术后1个月对照组ODI指数高于研究组,差异有统计学意义(P<0.05),术后6个月两组ODI指数差异无统计学意义(P>0.05)。术前两组炎症水肿区域体积差异无统计学意义(P>0.05),术后对照组炎症水肿区域体积大于研究组,差异有统计学意义(P<0.05)。对照组围手术期并发症总发生率为6.90%,研究组围手术期无并发症发生; 随访中对照组9例患者有腰背部疼痛(15.52%),研究组1例有腰背部疼痛(1.72%),两组并发症发生率比较差异有统计学意义(P<0.05)。结论:PPSIF治疗胸腰椎单节段骨折严格把握适应证可获得与开放手术相似的治疗效果,且术中创伤小、安全性高、术后并发症少。
Abstract:
Objective:To compare the clinical effects of percutaneous pedicle screw internal fixation(PPSIF)and posterior approach for open reduction and internal fixation in the treatment of thoracolumbar fracture,and to evaluate the clinical value of PPSIF for the treatment of thoracolumbar fracture.Methods:We retrospectively select 130 patients who were treated in our hospital from Jan 2012 to Feb 2016.According to thetreatment they recieved,130 cases were divided into study group who received PPSIF treatment and control group who received open reduction and internal fixation treatment.The operation condition,the Cobb angle,vertebral height ratio,Oswestry disability index(ODI),pain score(VAS)before the operation,5 days and 6 months after the operation were observed in all patients.MRI was used to observe the pre-and post-operative inflammatory edema of the surgery region.Results:The difference of operation time between the two groups was insignificant(P>0.05).Compared with study group,fluoroscopy times were fewer in control group(P<0.05)while the amount of blood loss and wound drainage were more and longer time of off-bed.(P<0.05).There was no significant difference in postoperative Cobb angles and vertebral height ratio between the two groups(P>0.05). VAS scores were higher in the control group than in the study group at day 1 and day 3 after the operation,and the difference was statistically significant(P<0.05).VAS scores were still higher in control group than study group 5 days and 6 months after the operation,but there was no statistically significant difference(P>0.05).Before operation,there was no significant difference in ODI index between the two groups(P>0.05).One month after operation,the ODI index in control group was greater than the study group,and the difference was statistically significant(P<0.05).Six months after operation,there was no significant difference in ODI index between the two groups(P>0.05)Before operation,there was no significant difference in flammatory edema volume between the two groups(P>0.05).After operation,the flammatory edema area in control group was greater than the study group,and the difference was statistically significant(P<0.05).The total perioperative complication rate was 6.90% in control group,while there were no complications in the study group during the perioperative period.During the follow-up,9 patients in the control group had lumbar back pain,with the incidence rate 15.52%,and 1 patient in the study group had lumbar back pain,with the incidence rate 1.72%.There was significant difference in the complication rate between the two groups(P<0.05).Conclusion:Percutaneous pedicle screw internal fixation can achieve similar effects as open reduction if used strictly.It has the advantages of mini-invasion,good safety and few complications.

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更新日期/Last Update: 2017-08-15