开放经椎管植骨内固定术与微创经椎弓根植骨内固定术治疗胸腰椎骨折的近期疗效比较

发布时间：2018-04-12 00:16

  本文选题：胸腰椎骨折 + 微创　； 参考：《遵义医学院》2015年硕士论文

【摘要】：目的:探讨开放经单侧椎管植骨内固定手术与微创经椎弓根植骨内固定手术治疗胸腰椎骨折的近期疗效比较,为临床应用提供科学依据。方法:选取2013年3月~2014年5月期间遵义医学院附属医院脊柱外科收治39例胸腰椎骨折的临床资料,并选用两种不同的手术方法进行疗效比较:1.开放经单侧椎管植骨内固定手术;2.微创经椎弓根植骨内固定手术;微创组16例,开放组23例,术后随访8~15月,通过对两手术患者之间围手术期相关指标、近期随访的影像学指标、术后腰背部疼痛症状改善的情况进行比较并做出统计学分析。结果:1、围手术期参数微创组在手术时间、术中出血量、术区引流量及住院天数具有优势,但“X”线暴露时间较长,微创组和开放组比较具有统计学差异(P0.05)。2、影像学结果微创组和开放组术后的伤椎椎体前缘高度、Cobb角度数、矢状面指数较术前有改善,改善差异具有统计学意义(P0.05),但微创组术后伤椎前缘高度、Cobb角度数及矢状面指数的改善程度与开放组比较差异无统计学意义(P≥0.05),随访期间微创组和开放组的矫正度丢失差异无统计学意义(P≥0.05)。3、疼痛恢复情况评估微创组和开放组疼痛程度在术后3天均有减轻,两组减轻的程度与术前比较有改善,改善存在差异,差异具有统计学意义(P0.05)。微创组术后3月内疼痛程度改善更加明显,与开放组比较存在统计学意义(P0.05),但微创组及开放组术后12月及末次随访疼痛程度基本相同,比较无统计学差异(P≥0.05)。结论：1.在掌握手术适应症前提下治疗胸腰椎骨折,微创和开放两种手术方式治疗效果相当。2.虽然微创手术过程“X”透视时间较多,但在手术时间、术中出血量、术区引流量、住院时间及术后恢复并发症等方面的疗效优于开放手术。
[Abstract]:Objective: to compare the short-term curative effect of open unilateral vertebral canal graft internal fixation and minimally invasive transpedicular bone graft internal fixation in the treatment of thoracolumbar fractures, and to provide scientific basis for clinical application.Methods: from March 2013 to May 2014, 39 cases of thoracolumbar fractures were treated in the Department of Spine surgery, affiliated Hospital of Zunyi Medical College.Open bone graft internal fixation through unilateral spinal canal 2.Minimally invasive transpedicular bone graft internal fixation, minimally invasive group (16 cases) and open group (23 cases) were followed up for 8 ~ 15 months.The improvement of lumbar and back pain after operation was compared and statistically analyzed.Results: the microinvasive group had advantages in operation time, intraoperative bleeding volume, drainage volume and hospitalization days, but the exposure time of "X" ray was longer than that of the control group.There was significant difference between the minimally invasive group and the open group (P 0.05). The results of the imaging results showed that the anterior height of the injured vertebrae in the minimally invasive group and the open group were improved by Cobb angle and sagittal index.The difference was statistically significant (P > 0.05), but there was no significant difference in the degree of improvement of Cobb angle and sagittal index between the minimally invasive group and the open group (P 鈮，

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