过伸复位法结合椎弓根钉内固定术治疗单纯性胸腰椎骨折的临床疗效观察

发布时间：2018-05-20 17:31

本文选题：胸腰椎骨折 + 过伸复位　；参考：《福建中医药大学》2017年硕士论文

【摘要】：目的:本研究课题旨在观察与分析过伸复位法结合椎弓根钉内固定术治疗胸腰椎骨折的临床疗效,通过与传统后路切开复位内固定术的对比研究,评价过伸复位法结合椎弓根钉内固定术在临床治疗上的应用价值。方法:本研究选取2016年01月至2017年01月在厦门大学附属福州第二医院脊柱外科住院的符合纳排标准的60例T12-L2胸腰椎骨折患者,根据住院先后顺序编号,按照随机数字表法分为治疗组和对照组,两组均为30例。实验组在全麻下过伸复位法结合椎弓根钉内固定术;对照组在全麻下行传统后路切开复位内固定术。并以治疗前后的疼痛评分、Cobb角度改变、椎体前后缘高度恢复率及丢失率、手术时间、出血量作为临床观察指标,比较两组间及各组内治疗前后不同时段的差异性,并记录术后不良反应的发生情况。结果:两组60例患者均获得随访,随访时间3个月,所有患者均能配合治疗。实验组的手术时间较对照组平均缩短约26.5分钟(P0.01),术中出血量无明显差异(P0.05)。两组患者在治疗后的疼痛数字模拟评分上均有明显改善(P0.01),组间差异无统计学意义(P0.05)。术后即刻两组治疗结果均能够有效改善Cobb角度及椎体前后缘高度(P0.01);在随访时两组患者的Cobb角度均有一定程度丢失(P0.01),术后6周椎体前缘高度丢失有明显差异(P0.01),术后6周至12周椎体前缘高度丢失无明显差异(P0.05),各时间段组间对比差异无统计学意义(P0.05)。60例患者中仅1例出现切口愈合不良,未出现其他严重的并发症及意外事件。结论:与传统后路切开复位内固定术相比,过伸复位法结合椎弓根钉内固定术同样可以有效缓解患者疼痛,改善术后患者Cobb角及伤椎高度,并且能够明显缩短手术时间,降低手术难度。该方法将中医手法复位与西医手术相结合,是安全、有效的,是对胸腰椎骨折治疗的有益补充。
[Abstract]:Objective: to observe and analyze the clinical effect of extension reduction combined with pedicle screw fixation in the treatment of thoracolumbar fractures. To evaluate the clinical value of extension reduction combined with pedicle screw fixation. Methods: from January 2016 to January 2017, 60 patients with T12-L2 thoracolumbar fractures who were hospitalized in the Department of Spinal surgery, Fuzhou Hospital affiliated to Xiamen University, were selected and numbered according to the order of hospitalization. According to the method of random digital table, 30 cases were divided into treatment group and control group. The experimental group was treated with extension reduction under general anesthesia combined with pedicle screw fixation, while the control group was treated with traditional posterior open reduction and internal fixation under general anesthesia. The changes of Cobb angle before and after treatment, the recovery rate and loss rate of anterior and posterior edge of vertebral body, the time of operation and the amount of blood loss were used as clinical observation indexes to compare the differences between the two groups and between the two groups before and after treatment. The incidence of adverse reactions after operation was recorded. Results: 60 patients in both groups were followed up for 3 months. The operative time of the experimental group was 26.5 minutes shorter than that of the control group (P 0.01). There was no significant difference in the blood loss during the operation between the experimental group and the control group (P 0.05). The pain numerical analogue scores of the two groups were significantly improved after treatment (P 0.01), but there was no significant difference between the two groups (P 0.05). Immediately after operation, the results of treatment in both groups could effectively improve the angle of Cobb and the height of anterior and posterior edge of vertebral body P0.01.The Cobb angle of the two groups was lost to a certain extent at the follow-up, and there was significant difference in the loss of anterior height of vertebral body 6 weeks after operation (P 0.01), and there was a significant difference in the loss of anterior height of vertebral body 6 weeks after operation (P 0.01). From 6 to 12 weeks, there was no significant difference in the loss of anterior height of vertebral body (P 0.05). There was no significant difference in comparison between different groups (P 0.05), and only 1 case had poor wound healing in 6 weeks to 12 weeks. There were no other serious complications or accidents. Conclusion: compared with the traditional posterior open reduction and internal fixation, extension reduction combined with pedicle screw fixation can effectively relieve pain, improve the Cobb angle and the height of injured vertebrae, and shorten the operation time. Reduce the difficulty of operation. This method is safe and effective and is a useful supplement to the treatment of thoracolumbar fractures.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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