微创经皮椎弓根螺钉附加伤椎固定治疗无神经损伤胸腰椎骨折的临床研究
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摘要
目的：探讨微创经皮与开放椎弓根螺钉附加伤椎固定治疗无神经损伤胸腰椎骨折的疗效。
方法：选取2008年10月至2009年10月40例胸腰椎骨折病例,随机分成A、B两组,A组给予开放切开复位经伤椎6钉固定,B组给予微创经伤椎6钉固定,通过对围手术期参数如术中出血量、术后引流量、手术时间,影像学资料的cobb's角改变、椎体前缘高度,及临床效果评价等临床资料收集,术后随访时间从9个月到48个月,获取影像学参数,并对比研究分析。结果：有5例病例失去随访,平均随访22个月,通过微创组与开放组比较,在术中出血量(A：370.59±52.73,B：68.89±19.97,p<0.05)、术后引流量(A：366.47±51.10,B：14.11±3.74,p<0.05)、手术时间(A：2.19±0.32,B：1.48±0.18,p<0.05),疼痛VAS评分改善(A：2.33±0.47,B：1.11±0.32,p<0.05),Oswestry障碍指数改善(A：42.36±4.33,B：14.13±3.30,p<0.05)差异具有统计学意义而住院日(A：17.17±2.35,B：11.06±2.10,p>0.05)术后椎体前后缘高度(A：26.78±4.71,B：22.61±4.27,p>0.05)、coob角改善(A：16.94±3.42,B：15.67±3.53,p>0.05)差异无统计学意义。
结论：微创经皮内固定取得了与开放手术在伤椎术前、术后高度改善及cobb's角改善上无明显差别,而在手术时间、出血量及引流量、术后腰背部疼痛改善等方面有较大优势。对于无需减压的胸腰椎压缩性骨折,选择经皮椎弓根螺钉固定治疗,创伤小,疗效肯定,不失为一种较好的临床治疗方法。
Objective:To investigate the surgical therapeutic result of thoracolumbar fracture without neurological damage by percutaneous pedicle screw fixation with fixation through the pedicle of fractured vertebra.
Methods:From October2008to October2009,a total of40thoracolumbar-fracture patients were divided into two groups. Group A:20cases were included in the open pedicle screw fixation,Group B:20cases were in percutaneous pedicle screw fixation with injured vertebra.The perioperative index including the surgical blood loss, surgical draining loss, surgical time, hospital stay and VAS score, the Cobb's angle, the Oswestry index, and anterior height of the fracture vertebral body were compared.
Results:There were5patients failed in follow-up,3patients in A group and2in B group. There were significant differences in the surgical blood loss (A:370.59±52.73, B:68.89±19.97, p<0.05), surgical draining loss(p<0.05), surgical time (A:2.19±0.32, B:1.48±0.18, p<0.05), VAS score (A:2.33±0.47, B:1.11±0.32, p<0.05)and Oswestry index (A:42.36±4.33, B:14.13±3.30.. p<0.05) between the two groups. The Cobb's angle (A:16.94±3.42, B:15.67±3.53, p>0.05), hospital stay (A:17.17±2.35, B:11.06±2.10, p>0.05) and anterior height of the fracture vertebral body (A:26.78±4.71, B:22.61±4.27, p>0.05) were all significantly different between pre-operation and post-operation in each group.There was no significant difference in postoperative improvement of Cobb's angle in each group in the follow-up(P>0.05) but there was significant difference in postoperative improvement of anterior height (P<0.05) of fractured vertebral body in the two groups.
Conclusion:Achieved with open surgery minimally invasive percutaneous internal fixation in injured vertebral surgery postoperative height improvement and has no obvious difference on the cobb's Angle improved, and in the operation time, blood loss, postoperative lumbar back pain improved and flow has a larger advantage. For thoracolumbar compression fractures without decompression, percutaneous pedicle screw fixation for choice, trauma small, curative effect affirmation, can yet be regarded as a better clinical treatment method.
方法：选取2008年10月至2009年10月40例胸腰椎骨折病例,随机分成A、B两组,A组给予开放切开复位经伤椎6钉固定,B组给予微创经伤椎6钉固定,通过对围手术期参数如术中出血量、术后引流量、手术时间,影像学资料的cobb's角改变、椎体前缘高度,及临床效果评价等临床资料收集,术后随访时间从9个月到48个月,获取影像学参数,并对比研究分析。结果：有5例病例失去随访,平均随访22个月,通过微创组与开放组比较,在术中出血量(A：370.59±52.73,B：68.89±19.97,p<0.05)、术后引流量(A：366.47±51.10,B：14.11±3.74,p<0.05)、手术时间(A：2.19±0.32,B：1.48±0.18,p<0.05),疼痛VAS评分改善(A：2.33±0.47,B：1.11±0.32,p<0.05),Oswestry障碍指数改善(A：42.36±4.33,B：14.13±3.30,p<0.05)差异具有统计学意义而住院日(A：17.17±2.35,B：11.06±2.10,p>0.05)术后椎体前后缘高度(A：26.78±4.71,B：22.61±4.27,p>0.05)、coob角改善(A：16.94±3.42,B：15.67±3.53,p>0.05)差异无统计学意义。
结论：微创经皮内固定取得了与开放手术在伤椎术前、术后高度改善及cobb's角改善上无明显差别,而在手术时间、出血量及引流量、术后腰背部疼痛改善等方面有较大优势。对于无需减压的胸腰椎压缩性骨折,选择经皮椎弓根螺钉固定治疗,创伤小,疗效肯定,不失为一种较好的临床治疗方法。
Objective:To investigate the surgical therapeutic result of thoracolumbar fracture without neurological damage by percutaneous pedicle screw fixation with fixation through the pedicle of fractured vertebra.
Methods:From October2008to October2009,a total of40thoracolumbar-fracture patients were divided into two groups. Group A:20cases were included in the open pedicle screw fixation,Group B:20cases were in percutaneous pedicle screw fixation with injured vertebra.The perioperative index including the surgical blood loss, surgical draining loss, surgical time, hospital stay and VAS score, the Cobb's angle, the Oswestry index, and anterior height of the fracture vertebral body were compared.
Results:There were5patients failed in follow-up,3patients in A group and2in B group. There were significant differences in the surgical blood loss (A:370.59±52.73, B:68.89±19.97, p<0.05), surgical draining loss(p<0.05), surgical time (A:2.19±0.32, B:1.48±0.18, p<0.05), VAS score (A:2.33±0.47, B:1.11±0.32, p<0.05)and Oswestry index (A:42.36±4.33, B:14.13±3.30.. p<0.05) between the two groups. The Cobb's angle (A:16.94±3.42, B:15.67±3.53, p>0.05), hospital stay (A:17.17±2.35, B:11.06±2.10, p>0.05) and anterior height of the fracture vertebral body (A:26.78±4.71, B:22.61±4.27, p>0.05) were all significantly different between pre-operation and post-operation in each group.There was no significant difference in postoperative improvement of Cobb's angle in each group in the follow-up(P>0.05) but there was significant difference in postoperative improvement of anterior height (P<0.05) of fractured vertebral body in the two groups.
Conclusion:Achieved with open surgery minimally invasive percutaneous internal fixation in injured vertebral surgery postoperative height improvement and has no obvious difference on the cobb's Angle improved, and in the operation time, blood loss, postoperative lumbar back pain improved and flow has a larger advantage. For thoracolumbar compression fractures without decompression, percutaneous pedicle screw fixation for choice, trauma small, curative effect affirmation, can yet be regarded as a better clinical treatment method.
引文
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