微创经皮椎弓根螺钉结合椎体成形术治疗无神经症状中老年胸腰椎爆裂性骨折的临床效果
摘要
目的观察微创经皮椎弓根螺钉结合椎体成形术治疗无神经症状中老年胸腰椎爆裂性骨折的临床效果。方法选取2015年1月至2017年5月广宁县人民医院收治的40例无神经症状中老年胸腰椎爆裂性骨折患者,给予患者微创经皮椎弓根螺钉结合椎体成形术,采用前瞻性分析方法观察临床治疗效果,包括手术相关指标(术中出血量、手术时间、住院时间及切口、肺部、尿路感染发生情况)、疼痛程度[视觉模拟评分量表(VAS)评分]、X线和CT测量值(伤椎前缘高与理论高比、伤椎后缘高与正常比、Cobb角、椎管矢状径比、椎管横段面积比)。结果手术时间为(66.25±8.25)min,住院时间为(8.55±2.32)d,术中失血量为(43.25±6.85)mL。患者围手术期并未出现尿路、肺部、切口感染等并发症。术后2 d、6个月、1 a,患者VAS评分较术前下降,差异有统计学意义(均P<0.05)。术后1周、1 a,伤椎前缘高与理论高比、伤椎后缘高与正常比、Cobb角、椎管矢状径比、椎管横段面积比与术前比较,差异有统计学意义(均P<0.05)。结论应用微创经皮椎弓根螺钉结合椎体成形术治疗无神经症状中老年胸腰椎爆裂性骨折,效果确切,值得临床推广应用。
引文
[1] 于荣华,朱晓东,梁朝革,等.微创经皮钉结合椎体成形术治疗无神经症状中老年胸腰椎爆裂性骨折[J].创伤外科杂志,2018,20(4):249-252.
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[3] SCHEER J K,BAKHSHESHIAN J,FAKURNEJAD S,et al.Evidence-Based Medicine of Traumatic Thoracolumbar Burst Fractures:A Systematic Review of Operative Management across 20 Years[J].Global Spine J,2015,5(1) :73-82.
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[5] TAKAMI M,YAMADA H,NOHDA K,et al.A minimally invasivesurgery combining temporary percutaneous pedicle screw fixation without fusion and vertebroplasty with transpedicu-lar intracorporeal hydroxyapatite blocks grafting for freshthoracolumbar burst fractures:prospective study[J].Eur J Orthop Surg Trauma,2014,24(11):159-165.
[6] 张文武,申勇.后路长节段椎弓根螺钉固定治疗胸腰椎骨折的疗效评[J].中国矫形外科杂志,2014,22(6):487-492.
[7] DHALL S S,WADHWA R,WANG M Y,et al.Traumatic thoraco-lumbar spinal injury:an algorithm for minimally invasive surgical management[J].Neurosurg Focus,2014,37(1):E9.
[8] LI C B,PAN J F,GU Y T.Minimally invasive pedicle screwfixation combined with percutaneous vertebroplasty for the treatment of thoracolumbar burst fracture[J].Int J Surg,2016,36(PtA):255-260.
[9] CHOU P H,MA H L,WANG S T,et al.Fusion may not be a necessary procedure for surgically treated burst fractures of the thoracolumbar and lumbar spine:a follow-up of at least ten years[J].J Bone Joint Surg Am,2014,96(20):1724-1731.
[10] TAKAMI M,YAMADA H,NOHDA K,et al.A minimally invasive surgery combining temporary percutaneous pedicle screw fixation without fusion and vertebroplasty with transpedicular intracorporeal hydroxyapatite blocks grafting for fresh thoracolumbar burst fractures:prospective study[J].Eur J Orthop Surg Traumatol,2014,24(Suppl 1):S159-S165.
[11] 宋晋刚,苗艳,崔易坤,等.椎体成形术治疗老年胸腰椎爆裂性骨折[J].中国微创外科杂志,2015,15(2):159-162.
[2] 谢鹏,贺西京,吕游,等.微创经皮入路对无神经症状胸腰椎爆裂性骨折的有效性和安全性研究[J].中国医学前沿杂志(电子版),2017,9(3):120-123.
[3] SCHEER J K,BAKHSHESHIAN J,FAKURNEJAD S,et al.Evidence-Based Medicine of Traumatic Thoracolumbar Burst Fractures:A Systematic Review of Operative Management across 20 Years[J].Global Spine J,2015,5(1) :73-82.
[4] DAHDALEH N S,SMITH Z A,HITCHON P W.Percutaneous pediclescrew fixation for thoracolumbar fractures[J].Neurosurg Clin N Am,2014,25(2):337-346.
[5] TAKAMI M,YAMADA H,NOHDA K,et al.A minimally invasivesurgery combining temporary percutaneous pedicle screw fixation without fusion and vertebroplasty with transpedicu-lar intracorporeal hydroxyapatite blocks grafting for freshthoracolumbar burst fractures:prospective study[J].Eur J Orthop Surg Trauma,2014,24(11):159-165.
[6] 张文武,申勇.后路长节段椎弓根螺钉固定治疗胸腰椎骨折的疗效评[J].中国矫形外科杂志,2014,22(6):487-492.
[7] DHALL S S,WADHWA R,WANG M Y,et al.Traumatic thoraco-lumbar spinal injury:an algorithm for minimally invasive surgical management[J].Neurosurg Focus,2014,37(1):E9.
[8] LI C B,PAN J F,GU Y T.Minimally invasive pedicle screwfixation combined with percutaneous vertebroplasty for the treatment of thoracolumbar burst fracture[J].Int J Surg,2016,36(PtA):255-260.
[9] CHOU P H,MA H L,WANG S T,et al.Fusion may not be a necessary procedure for surgically treated burst fractures of the thoracolumbar and lumbar spine:a follow-up of at least ten years[J].J Bone Joint Surg Am,2014,96(20):1724-1731.
[10] TAKAMI M,YAMADA H,NOHDA K,et al.A minimally invasive surgery combining temporary percutaneous pedicle screw fixation without fusion and vertebroplasty with transpedicular intracorporeal hydroxyapatite blocks grafting for fresh thoracolumbar burst fractures:prospective study[J].Eur J Orthop Surg Traumatol,2014,24(Suppl 1):S159-S165.
[11] 宋晋刚,苗艳,崔易坤,等.椎体成形术治疗老年胸腰椎爆裂性骨折[J].中国微创外科杂志,2015,15(2):159-162.