一种新型胸腰椎骨折经皮椎弓根螺钉复位内固定体外撑开器的设计与临床应用研究

发布时间：2018-06-16 05:10

本文选题：胸腰椎骨折 + 微创性　；参考：《中国修复重建外科杂志》2017年01期

【摘要】：目的设计一种新型经皮椎弓根螺钉复位内固定体外撑开器(简称"新型撑开器"),评价其应用于胸腰椎骨折治疗的疗效。方法根据胸腰椎骨折机制和复位力学特点,自行设计新型撑开器,并结合U形长尾空心椎弓根钉棒系统,于2014年1月—2016年1月采用经皮微创椎弓根螺钉复位内固定治疗36例单节段无神经损伤胸腰椎骨折患者(A组),并与同期采用传统开放椎弓根螺钉复位内固定治疗的39例胸腰椎骨折患者(B组)临床资料进行比较。两组患者性别、年龄、致伤原因、骨折分型、骨折节段、受伤至手术时间以及术前伤椎前、中、后缘高度百分比和伤椎后凸角比较差异均无统计学意义(P0.05),具有可比性。记录并比较两组手术时间、切口长度、术中出血量、术后引流量、术后24 h切口疼痛视觉模拟评分(VAS)、患者X射线暴露次数、离床下地活动时间及术后伤椎前、中、后缘高度百分比、后凸角及矫正度。结果 A组手术时间、手术切口长度、术中出血量、术后引流量、术后24 h伤口VAS评分、离床下地活动时间均优于B组,B组患者X射线暴露次数优于A组,差异均有统计学意义(P0.05)。两组患者均获随访,随访时间7~15个月,平均11.2个月。均未出现医源性神经根损伤及术后感染、内植物断裂、折弯等术中及术后并发症。A组1例术中出现2枚椎弓根螺钉轻度拔钉。两组术后3 d伤椎前、中、后缘高度百分比及伤椎后凸角均较术前显著改善(P0.05);但术后3 d两组间上述指标及伤椎后凸角矫正度比较差异均无统计学意义(P0.05)。结论与传统开放椎弓根螺钉复位内固定比较,应用新型撑开器经皮微创椎弓根螺钉复位内固定治疗胸腰椎骨折创伤小、出血少、恢复快,骨折撑开复位效果满意。
[Abstract]:Objective to design a new percutaneous pedicle screw external fixator for thoracolumbar fractures. Methods according to the mechanism of thoracolumbar fracture and the characteristics of reduction mechanics, a new type of distractor was designed and combined with the U-shaped long tail hollow pedicle screw rod system. From January 2014 to January 2016, 36 patients with single level thoracolumbar fractures without nerve injury were treated with percutaneous minimally invasive pedicle screw reduction and internal fixation, and treated with traditional open pedicle screw reduction and internal fixation. The clinical data of 39 patients with thoracolumbar fracture in group B were compared. There were no significant differences between the two groups in sex, age, cause of injury, fracture classification, fracture segment, time from injury to operation, prevertebral, middle, posterior edge height percentage and kyphosis angle of injured vertebrae (P 0.05). The operation time, incision length, intraoperative bleeding volume, postoperative drainage volume, visual analogue score of incision pain 24 hours after operation were recorded and compared between the two groups. Percentage of trailing edge height, kyphoid angle and correction. Results the time of operation, the length of incision, the amount of intraoperative bleeding, the postoperative drainage volume, the VAS score of wound 24 hours after operation, and the time of moving out of bed in group A were better than those in group B (group B), and the times of X-ray exposure in group B were better than those in group A. The difference was statistically significant (P 0.05). The patients in both groups were followed up for 7 ~ 15 months (mean 11.2 months). No iatrogenic nerve root injury or postoperative infection was found in all cases. In group A, 2 pedicle screws were slightly removed from the pedicle screws in group A, including intraoperative and postoperative complications such as internal vegetative rupture, bending and other complications. On the 3rd day after operation, the percentage of height of middle and posterior edge and the kyphosis angle of injured vertebrae in the two groups were significantly improved compared with those before operation, but there was no significant difference in the above indexes and the correction degree of the injured kyphosis angle between the two groups on the 3rd day after operation. Conclusion compared with the traditional open pedicle screw reduction and internal fixation, the new distraction apparatus is used to treat thoracolumbar fractures with less trauma, less bleeding, faster recovery and satisfactory reduction effect.
【作者单位】：贵阳市第四人民医院(贵阳骨科医院)脊柱外科;
【基金】：贵阳市科技计划项目([20141001]20)~~
【分类号】：R687.3

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