微创治疗胸腰椎骨折中可调节角度的椎弓根螺钉的应用

发布时间：2018-04-09 19:30

本文选题：微创　切入点：胸腰椎骨折　出处：《皖南医学院》2015年硕士论文

【摘要】：目的:通过运用可调节角度的椎弓根螺钉治疗无神经损伤胸腰椎骨折患者的临床疗效。方法:2010年1月-2013年12月期间,我科收治的单节段无神经症状的胸腰椎骨折患者74例,其中男41例,女33例,年龄24岁-56岁,平均(35.6±9.1)岁。其中行传统后路切开复位椎弓根螺钉固定者22例,行Sextant系统经皮椎弓根螺钉固定者20例,行上海锐植公司开发的RTS系统可调节经皮椎弓根螺钉固定者32例。观察并记录患者术中出血量,手术时间、住院时间及视觉模拟评分标准(visual analogue scale,VAS),根据影像学结果记录术前,术后一周及末次随访伤椎前缘高度比值和后凸Cobb角变化。结果:所有患者术后平均随访(2.5±1.1)年。随访期间所有患者未出现因螺钉位置欠佳引起的神经症状及螺钉松动、退钉及断钉等现象。Sextant组和RTS组患者的手术时间,术中出血量及住院时间较开放组均明显降低,差异有统计学意义(P0.05),开放组与Sextant组和RTS组比较,术前、术后一周和末次随访的伤椎前缘高度比值和后凸Cobb角差异无统计学意义(P0.05)。VAS评分中,三组术前与末次随访差异无统计学意义(P0.05),术后一周VAS评分开放组与Sextant组和RTS组比较,差异有统计学意义(P0.05)。三组中,术前的VAS评分、伤椎前缘高度比值和后凸Cobb角与术后一周和末次随访的VAS评分、伤椎前缘高度比值和后凸Cobb角比较,差异有统计学意义(P0.05)。结论:与传统的开放手术相比,微创经皮可调节角度的椎弓根螺钉内固定技术具有创伤小,术中出血少,手术时间与住院时间短等优点,且矫正效果满意,是治疗胸腰椎骨折安全可靠的方式。
[Abstract]:Objective: to treat thoracolumbar fracture without nerve injury with adjustable angle pedicle screw.Methods: from January 2010 to December 2013, 74 cases of thoracolumbar fractures without neurological symptoms were treated in our department, including 41 males and 33 females, aged from 24 to 56 years, with an average age of 35.6 卤9.1 years.Among them, 22 cases were treated with traditional posterior open reduction, 20 cases with percutaneous pedicle screw fixation with Sextant system, and 32 cases with RTS system developed by Shanghai Rui Zhi Company.The intraoperative bleeding volume, operation time, hospitalization time and visual analogue score were observed and recorded. The changes of anterior height ratio and kyphosis Cobb angle were recorded according to the imaging results.Results: all patients were followed up for an average of 2.5 卤1.1 years.During the follow-up period, all the patients did not have the neurological symptoms caused by the poor screw position and the loosening of the screws. The operation time, intraoperative bleeding and hospitalization time of the patients in the Sextant group and RTS group were significantly lower than those in the open group.Compared with Sextant group and RTS group, there was no significant difference in anterior height ratio and kyphosis Cobb angle between the open group and the Sextant group.There was no significant difference between the three groups before and after the last follow-up (P 0.05), but there was a significant difference in the VAS score between the open group and the Sextant group and the RTS group one week after operation (P 0.05).In the three groups, the preoperative VAS score, the ratio of anterior height of injured vertebrae and the kyphosis Cobb angle were significantly higher than those of the VAS score of one week and the last follow-up, the ratio of anterior height of injured vertebrae and the Cobb angle of kyphosis.Conclusion: compared with the traditional open surgery, the minimally invasive percutaneous adjustable angle pedicle screw fixation has the advantages of less trauma, less bleeding, shorter operation time and shorter hospital stay, and the corrective effect is satisfactory.It is a safe and reliable way to treat thoracolumbar fractures.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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