两种手术方式治疗胸腰椎骨折脱位型损伤的疗效对比

发布时间：2018-03-13 07:05

  本文选题：胸腰椎骨折脱位　切入点：经肌间隙入路　出处：《遵义医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:比较后路经肌间隙椎弓根螺钉内固定术与传统开放椎弓根螺钉内固定术治疗胸腰椎骨折脱位型损伤的临床疗效。方法:选取2013年01月~2016年01月手术治疗胸腰椎骨折脱位型损伤患者40例进行回顾性分析(男,25;女,15),年龄在18~60岁。由于手术入路的不同,分为肌间隙入路组(Mis-open组)及传统开放入路组(Open组),其中Mis-open组行后路经肌间隙椎管减压、复位、植骨融合、椎弓根螺钉内固定术20例(男,12;女,8),年龄在21~60岁。术前美国脊髓损伤协会(American Spinal Injury Association,ASIA)神经功能分级:A级14例,B级5例,C级1例。Open组行传统开放椎管减压、复位、植骨融合、椎弓根螺钉内固定术20例(男,13;女,7),年龄在18~58岁。美国脊髓损伤分级(American Spinal Injury Association,ASIA)神经功能分级:A级14例、B级2例、C级3例、D级1例。1.分别采用计时器、负压吸引装置、负压引流球分别记录两组手术时间、中出血量、术后引流量,评估两组围手术期疗效。2.采用视觉模拟评分(Visual Analogue Score,VAS)评估两组术后切口疼痛情况。3.采用游标卡尺在伤椎电子计算机断层扫描(Computed Tomography,CT)横断位上测量椎管矢状径,计算两组术前及术后的椎管通畅率,评估两组椎管减压情况。4.分别采用游标卡尺、量角器在伤椎侧位平片上分别测量术前及术后的伤椎前缘高度的百分比、Cobb角,评估两组后凸矫正情况。5.采用ASIA分级标准评估两组患者的神经功能情况。40例患者随访了9~33个月,其中Mis-open组随访(19.3±5.6)个月,Open组随访(22.5±4.9)个月,差异无统计学意义(P0.05)。结果:1.Mis-open组的手术时间(240.5±38.3)min、术中出血量(525.0±168.2)ml、术后引流量(190.1±78.9)ml、术后24小时及末次随访VAS评分分别为(6.4±1.0、1.6±0.5)。末次随访椎管通畅率、伤椎前缘高度的百分比、Cobb角分别为(85.3±3.7)%、(85.5±2.7)%、(4.7±1.2)°。Mis-open组末次随访ASIA分级情况:7例A级、5例B级、6例C级、1例D级、1例E级。Open组的手术时间(258.5±43.7)min、术中出血量(770.0±269.2)ml、术后引流量(281.7±122.3)ml、术后24小时及末次随访VAS评分为(7.8±0.7、2.2±0.4),末次随访椎管通畅率、伤椎前缘高度的百分比、Cobb角分别为(85.8±1.8)%、(88.8±1.3)%、(5.3±1.5)°。Open组末次随访ASIA分级情况:6例A级、6例B级、5例C级、2例D级、1例E级。2.两组间在手术时间,术前、末次随访椎管通畅率、伤椎前缘高度的百分比、Cobb角指标比较无统计学差异(P0.05)。3.两组间在术中出血量、术后引流量、术后VAS评分上Mis-open组优于Open组,有统计学差异(P0.05)。4.同组内在末次随访时的VAS评分、椎管通畅率、伤椎前缘高度的百分比、Cobb角上比较术前,有统计学差异(P0.05)。5.两组间术前神经功能比较,差异没有统计学意义(Z=-0.42,P=0.68)。两组间末次随访神经功能比较,差异没有统计学意义(Z=-1.51,P=0.13)。Mis-open组组内术前和末次随访神经功能比较,差异有统计学意义(Z=-2.89,P=0.004);Open组组内术前和末次随访神经功能比较,差异有统计学意义(Z=-2.63,P=0.009)。结论:后路经肌间隙减压、复位、植骨融合、椎弓根螺钉内固定术治疗胸腰椎骨折脱位型损伤不仅能够有效恢复伤椎椎管通畅率及前缘高度的同时,还能减少手术创伤、术中出血、术后引流量、术后切口疼痛,是一种值得借鉴及推广的手术方式。
[Abstract]:Objective: To compare the clinical efficacy of the treatment of posterior dislocation injury of thoracolumbar fracture intermuscular pedicle screw fixation with traditional open pedicle screw fixation. Methods: from 2013 01 months ~2016 years 01 months of surgery in the treatment of patients with thoracolumbar fracture and dislocation injury in 40 cases were analyzed retrospectively (male, 25; female, 15), at the age of 18~60. Because of the different surgical approaches, divided into paraspinal approach group (group Mis-open) and traditional open approach group (Open group), Mis-open group underwent posterior intermuscular decompression, reduction, bone fusion and pedicle screw fixation in 20 cases (male, 12; female, 8), at the age of 21~60. Preoperative American Spinal Injury Association (American Spinal Injury Association, ASIA) nerve function grading: Grade A in 14 cases, 5 cases of grade B, grade C in 1 cases of.Open group underwent conventional open reduction, decompression, interbody fusion and pedicle screw fixation in 20 cases (male, 13; female , 7), at the age of 18~58. The classification of spinal cord injury (American Spinal Injury Association, ASIA) nerve function grading: Grade A in 14 cases, 2 cases of grade B, C grade 3 cases, D 1 cases of grade.1. respectively using the timer, negative pressure suction device, negative pressure drainage ball were recorded in the two groups in operation time, bleeding the amount, postoperative drainage, the perioperative effect of two groups was evaluated by visual analogue scale (.2. Visual Analogue Score, VAS) assessment of two groups of postoperative incision pain in vertebral.3. using vernier caliper computedtomography (Computed Tomography, CT) on the measurement of axial sagittal diameter of spinal canal, the two groups were calculated before and after the operation of the canal patency rate of two groups was evaluated respectively by.4. decompression in vertebral protractor vernier caliper, lateral radiographs were measured on preoperative and postoperative anterior vertebral height percentage, Cobb angle, kyphosis correction in two groups were assessed by.5. ASIA 绾ф爣鍑嗚瘎浼颁袱缁勬偅鑰呯殑绁炵粡鍔熻兘鎯呭喌.40渚嬫偅鑰呴殢璁夸簡9~33涓�鏈�,鍏朵腑Mis-open缁勯殢璁，

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