经皮椎弓根钉微创手术治疗脊柱骨折的效果及对患者脊柱功能的影响

张萌　李荣俊

[關键词] 脊柱功能;颈腰椎功能;并发症;脊柱骨折;经皮椎弓根微创手术

[中图分类号] R683.2          [文献标识码] B          [文章编号] 1673-9701（2021）27-0098-04

Effect of minimally invasive percutaneous pedicle screw surgery on spinal fractures and its influence on patients′ spinal function

ZHANG Meng1   LI Rongjun2

1.Department of Orthopedics， Affiliated Zhongshan Hospital of Dalian University， Dalian   116001，China; 2.Department of Orthopedics， Dalian Second People′s Hospital， Dalian   116011，China

[Abstract] Objective To investigate the effect of minimally invasive percutaneous pedicle screw surgery on spinal fractures and its influence on patients′ spinal function. Methods A total of 86 patients with spinal fractures from June 2018 to March 2020 were randomly divided into two groups. The control group（n=43） were treated with open internal fixation， while the study group（n=43） were treated with minimally invasive percutaneous pedicle surgery. The hospitalization stay， intraoperative blood loss， operation time， and pain score were compared between the two groups， to compare the treatment effect. Results The hospitalization stay in the study group was（7.01±1.10） days， which was shorter than that of （14.72±3.21） days in the control group ， with statistically significant difference（P<0.05）. The intraoperative blood loss in the study group was （73.35±9.52） mL， which was less than that of （149.96±12.13） mL in the control group， with statistically significant difference（P<0.05）. There was no statistically significant difference in operation time between the study group and the control group （P>0.05）. The pain score in the study group was （2.02±0.12） points， which was lower than that of （5.37±0.41） points in the control group， with statistically significant difference （P<0.05）. There was no statistically significant difference in the treatment excellent and good rate between the study group and the control group（P>0.05）. The NDI score after treatment in both groups were lower than those before treatment，and the JOA score after treatment in both groups were higher than those before treatment，with statistically significant difference （P<0.05）. After treatment， the NDI score in the study group was  lower than that in the control group，and the JOA score in the study group was higher than that in the control group，with statistically significant difference （P<0.05）. The total complication rate in the study group was 4.7%，which was lower than that of 27.9% in the control group， with statistically significant difference（P<0.05）. Conclusion Minimally invasive percutaneous pedicle surgery can relieve pain，shorten hospitalization stay，reduce intraoperative blood loss in the treatment of spinal fractures，indicating a significant therapeutic effect. It can effectively improve the cervical and lumbar spine function and is safe. It is worthy of clinical promotion.

[Key words] Spinal function; Cervical and lumbar spine function; Complications; Spinal fractures; Minimally invasive percutaneous pedicle surgery

脊柱骨折多数是由间接外力造成，主要人群为青壮年、男性，其中胸腰段骨折最为常见，常并发脊髓损伤，外伤后脊柱疼痛、畸形是临床主要表现[1]。脊柱能够保护人体的内脏，具有负重、平衡的作用，是人体的支柱，严重的脊柱损伤会造成患者截瘫，对患者的生命安全造成严重威胁，对生活质量有巨大影响[2]。手术治疗是脊柱骨折唯一治疗手段，为了保证疗效，一般采用保守治疗配合手术治疗，如固定、牵引、复位等，而治疗最终目的主要为减少后凸畸形、减少脊柱活动度丢失、维持并恢复脊柱的曲线和高度[3]。随着医学技术的迅速发展，微创手术逐渐广泛应用于脊柱骨折患者治疗，与传统开放式手术相比，经皮椎弓根微创手术术后恢复更快、出血量更少、手术切口更小[4]。本研究使用经皮椎弓根微创手术治疗脊柱骨折患者，探讨其治疗效果及其对患者脊柱功能的影响，现报道如下。

1 资料与方法

1.1一般资料

选取2018年6月至2020年3月大连大学附属中山医院脊柱骨折患者86例，随机分为对照组和研究组，每组各43例。对照组男28例，女15例，年龄23～49岁，平均（36.3±7.5）岁，骨折原因：高空坠落21例，意外摔伤6例，车祸伤16例;骨折类型：腰椎骨折26例，颈椎骨折7例，胸椎骨折10例。研究组男30例，女13例，年龄20～50岁，平均（36.5±7.3）岁，骨折原因：高空坠落19例，意外摔伤7例，车祸伤17例;骨折类型：腰椎骨折27例，颈椎骨折5例，胸椎骨折11例。……