| 摘要: |
| 目的：比较两种不同椎弓根钉内固定方法治疗无神经损伤胸腰椎骨折的疗效。方法：回顾性分析 80 例无神经损伤的胸腰椎骨折患者资料，按照内固定方法分为两组，常规组 43 例行切开椎弓根螺钉内固定治疗，微创组 37 例行微创通道下椎弓根螺钉固定治疗，均为伤椎短节段固定。比较两组术中出血量、手术时间、术后引流量及戴支具离床时间，手术前后伤椎侧位片 Cobb 角和矢状位指数，手术前后 Oswestry 功能障碍指数（ODI）和疼痛视觉模拟评分（VAS）。结果：两组平均随访时间为 14.25 个月。微创组术中出血量、手术用时、术后引流量及戴支具离床时间均明显低于常规组（P<0.05）；两组手术前后胸腰椎伤椎侧位片 Cobb 角和伤椎矢状位指数比较，均无明显差异。微创组术后 1 d VAS 评分较常规组明显降低（P<0.05），术后 3 个月微创组 ODI 评分明显低于常规组（P<0.05）。结论：微创通道下椎弓根螺钉固定对无神经损伤的单节段胸腰椎骨折具有良好的治疗效果，能缩短手术时间，减少术中出血，缓解疼痛。 |
| 关键词: 胸腰椎骨折 微创通道 椎弓根螺钉固定 神经损伤 |
| DOI：10.3969/j.issn.1007-6948.2019.04.016 |
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| 基金项目: |
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| Treatment of Thoracolumbar Fractures with Different Pedicle Screw Internal Fixations |
| LI Qing |
| Orthopedics Department, the Third People' s Hospital of Datong, Datong (037000), China |
| Abstract: |
| Objective To compare the curative effect of two different internal fixations with pedicle screws in the treatment of thoracolumbar fractures without nerve injury. Methods The data of 80 patients with thoracolumbar fracture without nerve injury were analyzed retrospectively. Patients were divided into two groups according to different internal ?xation methods. Forty-three patients in routine group were treated with open pedicle screw ?xation, and 37 patients in minimally invasive group were treated with pedicle screw ?xation under minimally invasive channels. The volume of intraoperative bleeding, operation time, postoperative drainage and time of leaving bed with braces, Cobb angle and sagittal index of lateral position of injured vertebrae before and after operation, oswestry dysfunction index (ODI) and visual analogue score of pain (VAS) before and after operation were compared between the two groups. Results The average follow-up time of the two groups was 14 . 25 months. The amount of intraoperative bleeding [( 67 . 9± 7 . 4 ) mL], operation time [( 65 . 0 ± 7.1) min], postoperative drainage volume [(46. 9± 9. 5) mL] and the time of leaving bed with braces [(2. 8± 1.2) d] in the minimally invasive group were significantly lower than those in the routine group [( 108 . 5± 18.5) mL, (84.9±12.0) min, (123.1±21.9) mL and (4.6±1.4) d, respectively, P<0.05]. There was no signi?cant difference in Cobb angle and sagittal index between the two groups before and after operation. The VAS score of minimally invasive group was 3.4±0.2 on day 1 after operation, which was signi?cantly lower than that of the routine group. The ODI score of minimally invasive group was at the 3rd month after operation, which was signi?cantly lower than that of the routine group. Conclusion Pedicle screw ?xation under minimally invasive channels has good therapeutic effects on single segment thoracolumbar fractures without nerve injury, which can shorten the operation time, reduce intraoperative bleeding and relieve pain. |
| Key words: Thoracolumbar fractures minimally invasive channels pedicle screw fixation nerve injury |
