经后路行椎弓根螺钉内固定结合伤椎内植骨手术治疗脊柱胸腰段骨折的近期效果

祁腾民 索南昂秀

[摘要] 目的 探讨脊柱胸腰段骨折治疗中经后路行椎弓根螺钉内固定结合伤椎内植骨手术的效果。 方法 选取2015年5月～2017年5月青海省人民医院骨科收治的脊柱胸腰段骨折患者60例，依据手术术式将患者分为经后路行椎弓根螺钉内固定结合伤椎内植骨手术组（研究组，n = 30）和经后路行椎弓根螺钉内固定结合外侧植骨融合术组（对照组，n = 30）两組，对两组患者的伤椎前后缘高度及头侧端椎上缘的垂线与尾侧端椎下缘垂线的交角（Cobb角）、椎管矢状径占位情况（Worter指数）、视觉模拟评分系统（VAS评分）、术中术后指标、临床疗效进行统计分析。 结果 手术后，研究组患者的伤椎前后缘高度均显著高于对照组，Cobb角显著低于对照组，差异有统计学意义（P < 0.05）；研究组患者的Worter指数、VAS评分均显著低于对照组，差异有统计学意义（P < 0.05）；研究组患者的切口长度、止痛针应用时间、住院时间均显著短于对照组，术中出血量、术后引流量均显著短于对照组，差异有统计学意义（P < 0.05）；研究组患者治疗的总有效率显著高于对照组，差异有统计学意义（P < 0.05）。 结论 脊柱胸腰段骨折治疗中经后路行椎弓根螺钉内固定结合伤椎内植骨手术较外侧植骨融合术的效果好，更能有效提升患者的伤椎前后缘高度比值，降低患者的Cobb角、Worter指数、VAS评分，缩短患者的切口长度、止痛针应用时间、住院时间，减少患者的术中出血量、术后引流量，提升患者治疗的总有效率。

[关键词] 椎弓根螺钉固定，经椎弓根植骨；脊柱胸腰段骨折；效果

[中图分类号] R826.64 [文献标识码] A [文章编号] 1673-7210（2018）05（c）-0084-05

Recent effect of posterior pedicle screw internal fixation combined with injured vertebral bone graft in the treatment of thoracolumbar fracture

QI Tengmin Suonan′angxiu

Department of Orthopedics， Qinghai Province People′s Hospital， Qinghai Province， Xining 810007， China

[Abstract] Objective To investigate the effect of posterior pedicle screw fixation combined with internal bone graft in the treatment of thoracolumbar fracture. Methods From May 2015 to May 2017， 60 patients with thoracolumbar fracture in Department of Orthopedics， Qinghai Province People′s Hospital were selected， they were divided into posterior pedicle screw fixation combined with vertebral bone graft surgical group （study group， n = 30） and posterior vertebral pedicle screw fixation combined with posterolateral bone fusion group （control group， n = 30）， according to surgical treatment methods， the vertebral anterior and posterior margin heights， cranial vertebral angle on the edge of the vertical and caudal vertebral edge vertical （Cobb angle）， position of the sagittal diameter of the vertebral canal （Worter index）， visual analogue scale （VAS） scores， intraoperation and postoperative indexes and clinical efficacy of the two groups were statistically analyzed. Results Compared with the control group， the height of the anterior and posterior margin of the injured vertebra in the study group were significantly higher， and the Cobb angle was significantly lower， the differences were statistically significant （P < 0.05）. Compared with the control group， the Worter index and VAS score in the study group were significantly lower， the differences were statistically significant （P < 0.05）. The length of incision， analgesic needle application time and hospitalization time， the intraoperative blood loss and postoperative drainage volume were significantly less than the control group， the differences were statistically significant （P < 0.05）. The total treatment effective rate of the study group was significantly higher than the control group， the differences were statistically significant （P < 0.05）. Conclusion The effect of posterior pedicle screw fixation combined with internal bone graft in the treatment of thoracolumbar fracture is better than posterolateral bone fusion， it can more effectively improve patients′ vertebral anterior and posterior height ratio， decrease patients′ Cobb angle， Worter index， VAS score， length of incision， shorten patients′ pain medication application time， hospitalization time， reduce patients′ intraoperative bleeding， postoperative drainage， improve patients′ total treatment efficiency.

[Key words] Pedicle screw fixation； Transpedicular bone graft； Thoracolumbar fracture； Effect

近年来，在胸腰段骨折的治疗中，经后路椎弓根螺钉复位內固定日益广泛地应用于临床，临床实践证实，其固定坚强、复位满意[1]。但是，也有相关医学研究表明[2]，在远期预后中，其极易有各种并发症发生，如后凸畸形、椎体高度丢失等。经后路椎弓根钉内固定联合后外侧植骨融合术将张力带的作用有效发挥了出来，途径为通过植骨对后柱进行融合，从而促进脊柱稳定的增强，对骨折复位进行有效维持。但是，其术后具有较为显著的椎体前缘高度比值丢失，无法对术后椎体高度丢失、后凸畸形等进行有效预防。……