经皮微创与常规切开椎弓根螺钉内固定治疗不稳定性胸腰椎骨折的临床分析
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摘要
目的分析不稳定性胸腰椎骨折(TLF)应用经皮微创椎弓根螺钉内固定(MIPPSO)与常规切开椎弓根螺钉内固定(COPSIF)治疗的疗效。方法选择2015年10月-2018年10月东莞市清溪医院收治的不稳定性TLF患者60例进行分组研究,以随机数表法分为观察组与对照组,每组30例。对照组用COPSIF治疗,观察组用MIPPSO治疗,记录两组手术时间、切口长度、手术出血量、住院时间,评价术前与术后伤椎前缘高度、后凸Cobb角、矢状位指数,并比较。结果两组手术时间比较无显著差异(P> 0.05),但观察组切口长度、手术出血量、住院时间均低于对照组,差异有统计学意义(P <0.05);两组术前伤椎前缘高度、后凸Cobb角、矢状位指数对比无显著差异(P> 0.05),术后两组对比也无显著差异(P> 0.05)。结论 MIPPSO与COPSIF治疗不稳定性TLF患者对伤椎前缘高度、后凸Cobb角、矢状位指数影响效果相当,同时二者手术时间并无显著差异,但MIPPSO手术切口更小,手术出血量更少,还可缩短手术时间,值得临床应用。
Objective To analyze the curative effect of unstable thoracolumbar fractures(TLF) treated with minimally invasive percutaneous pedicle screw osteosynthesis(MIPPSO) and conventional open pedicle screw internal fixation(COPSIF).Methods 60 patients with unstable TLF admitted to our hospital from October 2015 to October 2018 were selected and divided into observation group and control group by random number table method, with 30 cases in each group. The control group was treated with COPSIF, while the observation group was treated with MIPPSO. The operation time, incision length, operation bleeding volume and hospitalization time of the two groups were recorded, and the anterior edge height, kyphosis Cobb angle and sagittal index of the injured vertebra before and after operation were evaluated and compared. Results There was no significant difference in the operation time between the two groups(P > 0.05), but the incision length, operation bleeding volume and hospitalization time in the observation group were lower than those in the control group, the differences were statistically significant(P < 0.05). There was no significant difference in anterior height of injured vertebra, kyphosis Cobb angle and sagittal index between the two groups before operation(P > 0.05), and there was no significant difference between the two groups after operation(P > 0.05). Conclusion MIPPSO and COPSIF have the same effect on the anterior height of injured vertebra, kyphosis Cobb angle and sagittal index in the treatment of unstable TLF patients. At the same time, there is no significant difference in the operation time between the two groups. However, MIPPSO has smaller incision, less blood loss and shortened operation time, which is worthy of clinical application.
Objective To analyze the curative effect of unstable thoracolumbar fractures(TLF) treated with minimally invasive percutaneous pedicle screw osteosynthesis(MIPPSO) and conventional open pedicle screw internal fixation(COPSIF).Methods 60 patients with unstable TLF admitted to our hospital from October 2015 to October 2018 were selected and divided into observation group and control group by random number table method, with 30 cases in each group. The control group was treated with COPSIF, while the observation group was treated with MIPPSO. The operation time, incision length, operation bleeding volume and hospitalization time of the two groups were recorded, and the anterior edge height, kyphosis Cobb angle and sagittal index of the injured vertebra before and after operation were evaluated and compared. Results There was no significant difference in the operation time between the two groups(P > 0.05), but the incision length, operation bleeding volume and hospitalization time in the observation group were lower than those in the control group, the differences were statistically significant(P < 0.05). There was no significant difference in anterior height of injured vertebra, kyphosis Cobb angle and sagittal index between the two groups before operation(P > 0.05), and there was no significant difference between the two groups after operation(P > 0.05). Conclusion MIPPSO and COPSIF have the same effect on the anterior height of injured vertebra, kyphosis Cobb angle and sagittal index in the treatment of unstable TLF patients. At the same time, there is no significant difference in the operation time between the two groups. However, MIPPSO has smaller incision, less blood loss and shortened operation time, which is worthy of clinical application.
引文
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[7]巩腾,苏学涛,夏群,等.前后联合入路与单纯前路减压固定治疗不稳定性胸腰椎骨折的疗效比较[J].中华创伤骨科杂志,2018,20(4):303-311.
[8]陈太勇,曹广如,蔡玉强,等.半椎板切除减压、撬拨复位伤椎体内植骨治疗严重胸腰椎爆裂骨折32例观察[J].现代临床医学,2015,17(3):211-213.
[2]赵波,邱晓文,李萌,等.微创椎弓根螺钉治疗不稳定性胸腰椎骨折的疗效分析[J].医学临床研究,2017,34(2):247-249,252
[3]刘栋华.不同手术方法治疗不稳定性胸腰椎骨折疗效对比[J]牡丹江医学院学报,2017,38(1):71-72,75.
[4]范剑波,姚松柏,周娣,等.微创经皮椎弓根螺钉内固定治疗不稳定性胸腰椎骨折的临床研究[J].现代医药卫生,2017,33(16):2 468-2 470,2 473.
[5]张光祥,崔君智.经皮微创与常规切开椎弓根螺钉内固定治疗不稳定性胸腰椎骨折疗效比较[J].海南医学,2018,29(24)3 463-3 466.
[6]巩腾,苏学涛,夏群,等.胸腰椎骨折手术人路和术式适应证选择[J].武警医学,2018,29(1):89-93.
[7]巩腾,苏学涛,夏群,等.前后联合入路与单纯前路减压固定治疗不稳定性胸腰椎骨折的疗效比较[J].中华创伤骨科杂志,2018,20(4):303-311.
[8]陈太勇,曹广如,蔡玉强,等.半椎板切除减压、撬拨复位伤椎体内植骨治疗严重胸腰椎爆裂骨折32例观察[J].现代临床医学,2015,17(3):211-213.