微创椎弓根钉内固定术治疗不稳定胸腰椎骨折的疗效观察
|
摘要
目的比较椎弓根钉内固定术治疗不稳定胸腰椎骨折的两种置钉方法的疗效。方法无神经损伤的不稳定胸腰椎骨折患者70例,分别采用微创椎弓根螺钉内固定(35例)及开放椎弓根螺钉内固定术(35例)进行治疗,评估两组患者手术切口长度、手术时间、失血量、影像学指标、腰背疼痛改善情况。结果 70例均获得6~14个月的随访,平均随访10个月。两组在手术时间方面差异无统计学意义(P>0.05),在手术切口长度、失血量方面差异有统计学意义(P<0.05);两组术后矢状位后凸Cobb角、伤椎椎体前缘高度较术前均有明显改善(P<0.05),术后两组在Cobb角、伤椎前缘高度的改善程度比较差异无统计学意义(P>0.05);术后早期两组VAS评分比较差异有统计学意义(P<0.05),但术后半年时两组VAS评分比较差异无统计学意义(P<0.05)。结论微创椎弓根螺钉固定术是治疗无神经损伤不稳定胸腰椎骨折的有效方法,具有创伤小、恢复快的优点,临床值得推广应用。
Objective To compare the therapeutic effect between two pedicle screw fixation methods with different screw placing ways in treating unstable thoracolumbar fracture. Methods 70 thoracolumbar fracture patients without neurological symptoms were enrolled in the research. 35 patients were treated with minimally invasive percutaneous pedicle screw fixation and 35 cases with the traditional open pedicle screw fixation. Operation time,operative incision length and bleeding volume,radiographic index,and relief of the low back pain were documented and compared between the two groups. Results All patients have been followed up for 6 to14 months,10 months on the average. The consumed time of operation made no significant difference( P > 0. 05). There were significant differences in the length of size, surgical blood loss,( P < 0. 05). The Cobb angle,anterior height of the fracture vertebral body were all significantly improved after operation in each group( P < 0. 05). There was no significant difference in postoperative improvement of Cobb angle,or anterior height of the fracture vertebral body between the two groups( P > 0. 05). The improvement in VAS of back pain was of significant difference between the two groups until 6 months after the operation. Conclusions Minimally invasive percutaneous pedicle screw fixation is an effective method to treat thoracolumbar fracture,for it has the advantages of small trauma,less bleeding,light pain,and quick recovery.
Objective To compare the therapeutic effect between two pedicle screw fixation methods with different screw placing ways in treating unstable thoracolumbar fracture. Methods 70 thoracolumbar fracture patients without neurological symptoms were enrolled in the research. 35 patients were treated with minimally invasive percutaneous pedicle screw fixation and 35 cases with the traditional open pedicle screw fixation. Operation time,operative incision length and bleeding volume,radiographic index,and relief of the low back pain were documented and compared between the two groups. Results All patients have been followed up for 6 to14 months,10 months on the average. The consumed time of operation made no significant difference( P > 0. 05). There were significant differences in the length of size, surgical blood loss,( P < 0. 05). The Cobb angle,anterior height of the fracture vertebral body were all significantly improved after operation in each group( P < 0. 05). There was no significant difference in postoperative improvement of Cobb angle,or anterior height of the fracture vertebral body between the two groups( P > 0. 05). The improvement in VAS of back pain was of significant difference between the two groups until 6 months after the operation. Conclusions Minimally invasive percutaneous pedicle screw fixation is an effective method to treat thoracolumbar fracture,for it has the advantages of small trauma,less bleeding,light pain,and quick recovery.
引文
[1]韦玮,唐毓金,陆敏安.无脊髓神经损伤不稳定脊柱骨折的手术治疗[J].广西医学,2009,31(10):1483-1484.
[2]Gaines RW.The use of pedicle-screw internal fixation for the operative treatment of spinal disorders[J].J Bone Joint Surg(Am),2000,82:1458-1476.
[3]Carl AL,Tromanhauser SG,Roger DJ.Pedicle screw instrumentation for thoracolumbar burst fractures and fracture-dislocations[J].Spine,1992,17(8 Suppl):S317-S324.
[4]杨雷,李家顺,贾连顺,等.经皮椎弓根螺钉技术的解剖学基础及其临床意义[J].中国临床解剖学杂志,2004,22(1):58-62.
[5]Kim DY,Lee SH,Chung SK,et al.Comparison of multifidus muscle atrophy and trunk extension muscle strength:percutaneous versus open pedicle screw fixation[J].Spine,2005,30(1):123-129.
[6]刘邦忠,李泽兵.躯干肌在腰椎稳定性中的作用[J].中华物理医学与康复杂志,2003,1:47-48.
[7]Taylor H,Mc Gregor AH,Medhi-Zadeh S,et al.The impact of self-retaining retractors on the paraspinal muscles during posterior spinal surgery[J].Spine,2002,27:2758-2762.
[8]Park Y,Ha JW.Comparison of one-level posterior lumbar interbody fusion performed with a minimally invasive approach or a traditional open approach[J].Spine(Phila Pa1976),2007,32(5):537-543.
[9]Blumenthal S,Mc Afee PC,Guyer RD,et al.A prospective,randomized,multicenter Food and Drug Administration investigational device exemptions study of lumbar total disc replacement with the CHARITE artificial disc versus lumbar fusion:part I:evaluation of clinical outcomes[J].Spine(Phila Pa 1976),2005,30(14):1565-1575.
[10]Alexander R,Vaccaro MD,Eli M.Baron operative techniques:spine surgery[M].London:E lsevier,2009:293-300.
[11]Teitelbaum GP,Shaol ian S,M c Douga ll CG,et al.New percutaneously inserte spinal fixation system[J].Spine(Ph ila Pa1976),2004,29(6):703-709.
[12]黄其杉,彭茂秀,林焱,等.经皮椎弓根螺钉固定治疗胸腰椎骨折[J].中华骨科杂志,2005,25(12):758-760.
[13]黄文华,钟世镇.脊柱椎弓根螺钉手术可视化的研究进展[J].中国临床解剖学杂志,2001,19(4):372-373.
[2]Gaines RW.The use of pedicle-screw internal fixation for the operative treatment of spinal disorders[J].J Bone Joint Surg(Am),2000,82:1458-1476.
[3]Carl AL,Tromanhauser SG,Roger DJ.Pedicle screw instrumentation for thoracolumbar burst fractures and fracture-dislocations[J].Spine,1992,17(8 Suppl):S317-S324.
[4]杨雷,李家顺,贾连顺,等.经皮椎弓根螺钉技术的解剖学基础及其临床意义[J].中国临床解剖学杂志,2004,22(1):58-62.
[5]Kim DY,Lee SH,Chung SK,et al.Comparison of multifidus muscle atrophy and trunk extension muscle strength:percutaneous versus open pedicle screw fixation[J].Spine,2005,30(1):123-129.
[6]刘邦忠,李泽兵.躯干肌在腰椎稳定性中的作用[J].中华物理医学与康复杂志,2003,1:47-48.
[7]Taylor H,Mc Gregor AH,Medhi-Zadeh S,et al.The impact of self-retaining retractors on the paraspinal muscles during posterior spinal surgery[J].Spine,2002,27:2758-2762.
[8]Park Y,Ha JW.Comparison of one-level posterior lumbar interbody fusion performed with a minimally invasive approach or a traditional open approach[J].Spine(Phila Pa1976),2007,32(5):537-543.
[9]Blumenthal S,Mc Afee PC,Guyer RD,et al.A prospective,randomized,multicenter Food and Drug Administration investigational device exemptions study of lumbar total disc replacement with the CHARITE artificial disc versus lumbar fusion:part I:evaluation of clinical outcomes[J].Spine(Phila Pa 1976),2005,30(14):1565-1575.
[10]Alexander R,Vaccaro MD,Eli M.Baron operative techniques:spine surgery[M].London:E lsevier,2009:293-300.
[11]Teitelbaum GP,Shaol ian S,M c Douga ll CG,et al.New percutaneously inserte spinal fixation system[J].Spine(Ph ila Pa1976),2004,29(6):703-709.
[12]黄其杉,彭茂秀,林焱,等.经皮椎弓根螺钉固定治疗胸腰椎骨折[J].中华骨科杂志,2005,25(12):758-760.
[13]黄文华,钟世镇.脊柱椎弓根螺钉手术可视化的研究进展[J].中国临床解剖学杂志,2001,19(4):372-373.