直视下微创与经皮微创治疗胸腰段椎体骨折（T11-L2）的临床对比研究

发布时间：2018-03-09 09:36

本文选题：微创　切入点：胸腰段　出处：《青海大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:对比直视下微创与经皮微创治疗胸腰段椎体骨折(T11-L2)的临床疗效。方法:选择2014年11月至2015年06月青海大学附属医院脊柱外科收治无神经系统损伤的胸腰段椎体骨折50例作为研究对象,随机分为实验组与对照组。研究对象的入选标准:1受伤机制:通常由车祸、高处坠落伤等外伤史造成,排除骨质疏松、肿瘤等其他原因导致的病理性骨折;2年龄界限:18岁~55岁;3临床症状:不伴四肢感觉活动障碍,会阴部感觉障碍;4辅助检查:胸腰段X-Ray、胸腰段CT三维重建及MRI可见T11-L2单节段椎体骨折,诊断明确。实验组采用直视下微创椎弓根螺钉内固定术,对照组采用经皮微创椎弓根螺钉内固定术,分别记录两组患者的切口长度、手术时间、术中出血量、术中透视次数、住院时间、切口愈合状况、耗材费用,术前及术后3个月伤椎前缘高度比例、术后48h VAS评分数据资料进行临床对比研究。结果:实验组与对照组患者通过术后3个月定期复查拍摄胸腰段X线的方式进行术后随访。直视下微创组(实验组)切口长度10.42±0.63cm、手术时间87.20±4.65min、术中透视次数2.80±0.41次;经皮微创组(对照组)切口长度12.18±0.32cm、手术时间108.08±6.77min、术中透视次数13.76±1.92次,差异均存在统计学意义(p0.05),而实验组在术前及术后3个月伤椎前缘高度比例、术后48h VAS评分的数据与对照组比较,差异不存在统计学意义(p0.05)。实验组的耗材费用固定为28243.6元,对照组的耗材费用固定为30143.6元,在耗材的费用上实验组比对照组低;实验组与对照组患者的切口愈合状况均为I/甲即完全愈合,说明愈合效果一致。结论:直视下微创与经皮微创虽属不同微创术式,但在治疗无神经损伤性胸腰段椎体骨折(T11-L2)具有相同临床疗效,而直视下微创技术更易于术者掌握,且更为经济、避免过多的医源性辐射,具有经皮微创术式不可比拟的优点。
[Abstract]:Objective: to compare the clinical effects of minimally invasive and percutaneous minimally invasive treatment of thoracolumbar vertebral fractures under direct vision. Methods: from November 2014 to June 2015, the thoracolumbar segment with no nervous system injury was treated in the Department of Spinal surgery, Qinghai University affiliated Hospital. Fifty cases of vertebral body fracture were studied. The subjects were randomly divided into experimental group and control group. The study subjects were selected as the injury mechanism of 1: 1: usually caused by a history of injuries such as car accidents, falls from high places, and so on, excluding osteoporosis. Pathological fractures caused by tumors and other causes have a 2% age limit of 20 to 55 years old and clinical symptoms: no sensory dysfunction in the extremities, Accessory examination of perineal sensory disorders: thoracolumbar X-Ray, three-dimensional CT reconstruction of thoracolumbar segment and T11-L2 single level vertebral body fracture by MRI, the diagnosis was clear. The experimental group was treated with minimally invasive pedicle screw fixation under direct vision. The patients in the control group were treated with percutaneous minimally invasive pedicle screw fixation. The incision length, operation time, intraoperative blood loss, fluoroscopy times, hospital stay time, wound healing status and consumable cost were recorded respectively in the two groups. The ratio of anterior height of injured vertebrae before operation and 3 months after operation, Results: the patients in the experimental group and the control group were followed up by taking chest and lumbar X-ray regularly 3 months after operation. The minimally invasive group (experimental group) was followed up under direct vision (experimental group). The length of incision was 10.42 卤0.63 cm, the operative time was 87.20 卤4.65 min, the times of fluoroscopy was 2.80 卤0.41; In the percutaneous minimally invasive group (control group), the incision length was 12.18 卤0.32 cm, the operative time was 108.08 卤6.77 min, and the number of fluoroscopy was 13.76 卤1.92 times. The difference was statistically significant (P 0.05). There was no significant difference between the data of VAS score 48 hours after operation and that of the control group (P 0.05). The cost of consumables was fixed at 28243.6 yuan in the experimental group and 30143.6 yuan in the control group. The expense of the experimental group was lower than that of the control group. The wound healing status of the patients in the experimental group and the control group was I / A, which indicated that the healing effect was the same. Conclusion: minimally invasive and transdermal minimally invasive under direct vision are different minimally invasive procedures. But in the treatment of thoracolumbar vertebral fracture without nerve injury, T11-L2) has the same clinical effect, and the minimally invasive technique under direct vision is easier for the operator to master, more economical, avoid excessive iatrogenic radiation, and has the advantage that the percutaneous minimally invasive operation is incomparable to that of the percutaneous minimally invasive operation.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R687.3

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