经皮椎弓根钉治疗胸腰段骨折的效果

窦庆寅+仰明莉+谢晓萍

[摘要] 目的 探讨经皮椎弓根钉治疗胸腰段骨折的临床效果。 方法 选取2014年12月～2016年1月深圳市松岗人民医院收治的140例行经皮椎弓根钉固定治疗的胸腰段骨折患者作为研究组，另选取同期收治的100例行传统开放式手术治疗的胸腰段骨折患者作为对照组。比较两组患者术中出血量、手术时间、切口长度及手术疗效等。 结果 研究组的手术时间、切口长度、住院时间明显短于对照组，引流量、术中出血量明显少于对照组，差异均有统计学意义（P < 0.05）。与术前1 d比较，两组患者术后6个月的伤椎前缘高度明显升高，Cobb角明显变小，差异均有统计学意义（P < 0.05）；手术前后组间比较差异无统计学意义（P > 0.05）。与术前1 d比较，两组术后1周的视觉模拟评分（VAS）评分明显降低，术后6个月的Oswestry功能障碍指数（ODI）评分也明显降低，差异均有统计学意义（P < 0.05）；研究组术后1周的VAS评分明显低于对照组，差异有统计学意义（P < 0.05）；两组术后6个月的ODI评分比较，差异无统计学意义（P > 0.05）。 结论 经皮椎弓根钉固定术是一种微创手术，具有出血少、创伤小、疗效好、恢复快等优点，是治疗胸腰段骨折的理想术式。

[关键词] 胸腰段骨折；经皮椎弓根钉；脊柱骨折；微创；疗效

[中图分类号] R687.3 [文献标识码] A [文章编号] 1673-7210（2016）10（c）-0095-04

[Abstract] Objective To discuss the effect of percutaneous pedicle screw in treatment of thoracolumbar fractures. Methods One hundred and forty patients with thoracolumbar fracture treated with percutaneous pedicle screw fixation treatment in Songgang Peoples Hospital of Shenzhen City from December 2014 to January 2016 were selected as the study objects， 100 patients with thoracolumbar fracture were given conventional open surgical treatment were selected as the control group at the same time. The amount of bleeding， operation time， incision length， operative effect and so on were compared between two groups. Results The operation time， incision length， length of stay of patients in the study group were significantly shorter than those of patients of the control group， and the blood volume and blood loss were significantly less than those of the control group， the differences were statistically significant（P < 0.05）. Compared with the preoperative 1 d， the height of the injured vertebral height was significantly increased of patients of two groups， and Cobbs angle was significantly smaller 6 months after operation， the differences were statistically significant（P < 0.05）； and there was no significant difference between the groups， the difference was not statistically significant （P > 0.05）. Compared with preoperative 1 d， the VAS scores of the two groups were significantly decreased after 1 weeks of operation， 6 months after operation， ODI scores also decreased significantly， the difference was statistically significant （P < 0.05）； VAS score of 1 week after operation in the study group was significantly lower than that of control group， the difference was statistically significant （P < 0.05）； 6 months after operation， ODI scores of the two groups had no significant difference， the difference was not statistically significant （P > 0.05）. Conclusion Percutaneous pedicle screw fixation is a minimally invasive surgery， has the advantages of less bleeding， less trauma， good curative effect， quick recovery， and it is an ideal method in the treatment of thoracolumbar fracture.

[Key words] Thoracolumbar fractures； Percutaneous pedicle screw； Spinal fractures； Minimally invasive； Curative effect

脊柱骨折是临床较为常见的一种骨折类型，占全身骨折的5%～6%[1]，且以T10～L2胸腰段骨折最为多见。临床治疗胸腰段骨折多采用后路切开椎弓根钉内固定术，椎弓根钉内固定术治疗脊柱骨折是脊柱外科发展史上的重要里程碑之一，临床实践证实该术式的疗效显著，但在随访过程中也发现患者术后普遍存在顽固性腰背疼痛、僵硬，给患者的日常生活造成了极大的影响[2]。近年来，随着微创外科技术的不断进步与成熟，经皮椎弓根钉内固定微创手术在脊椎骨折中的应用也越来越普遍，该术式具有疗效好、创伤小、术后恢复快等优点。……