经皮微创单向实心椎弓根钉内固定治疗胸腰椎骨折

发布时间：2018-06-18 22:11

本文选题：胸椎 + 腰椎　；参考：《中国组织工程研究》2017年27期

【摘要】：背景:传统开放手术方式治疗脊柱胸腰段骨折会对患者造成较大创伤,有加速脊柱局部退变可能。新的微创手术方式减小了患者创伤,患者能得到更好的恢复,对传统手术提出挑战。目的:探讨经皮微创单向固定实心椎弓根钉植入内固定治疗胸腰椎骨折的操作要点和注意事项。方法:选择行经皮微创单向实心椎弓根钉内固定治疗单一胸腰椎骨折不伴有脊髓损伤患者27例,其中24例患者骨折椎体高度恢复良好,另3例通过适度加大椎弓根钉链接棒弧度辅助抗扭矩套筒套于椎弓根钉尾冒以后柱为支点张开脊柱前柱得到良好复位。观察手术时间、术中出血量,内固定前1d轴向翻身目测类比评分、内固定后第1天术区目测类比评分、内固定后第3天术区及轴向翻身目测类比评分。结果与结论:①27例患者108个椎体均在靶点细针参照法引导下经椎弓根途径穿刺置钉,穿刺顺利,98个椎体一次性穿刺成功,余10个椎体二次调整进针点穿刺置钉成功;②内固定后第3天轴向翻身目测类比评分显著低于内固定前1天(P0.001);内固定后第3天术区目测类比评分显著低于内固定后第1天(P0.001);③手术时间及经皮单向实心椎弓根钉内固定手术时间平均(109±18)min;术中出血平均(60±16)mL;④术后无神经根损害并发症发生;(5)结果说明,经皮单向实心椎弓根植入固定治疗不伴有脊髓损伤及椎间盘严重受损的单一胸腰椎骨折的微创手术方式有效且安全;靶点细针参照引导穿刺技术作为简单易行的方法能够显著降低经椎弓根途径的穿刺难度,具有极高的一次性穿刺成功率。
[Abstract]:Background: traditional open surgery for thoracolumbar spine fracture will cause greater trauma to patients, which may accelerate the local degeneration of spine. The new minimally invasive surgery reduces the trauma of patients and improves the recovery of patients. Objective: to explore the operative points and cautions for the treatment of thoracolumbar fractures by percutaneous minimally invasive unilateral fixation with solid pedicle nail. Methods: Twenty-seven patients with single thoracolumbar fracture without spinal cord injury were treated with percutaneous minimally invasive solid pedicle screw fixation. In the other 3 cases, the anterior column of the spine was opened at the fulcrum point of the pedicle nail, and the anterior column of the spine was well reduced by appropriately increasing the pedicle screw link bar Radian assisted with the anti-torque sleeve set after the end of the pedicle nail. The time of operation, the amount of blood loss during operation, the visual analogue score of axial turn over at 1 day before internal fixation, the visual analogue score of operation area on the first day after internal fixation, and the visual analogue score of operation area and axial turn over on the 3rd day after internal fixation were observed. Results and conclusion 108 vertebrae of 127 patients were punctured by pedicle method under the guidance of target fine needle reference method. The puncture was successful, 98 vertebrae were punctured successfully, and the remaining 10 vertebrae were punctured successfully at the point of readjustment of the vertebral body. 2 the visual analogies of axial rotation on the 3rd day after internal fixation were significantly lower than those on the first day of internal fixation (P 0.001), and the visual analogue scores of operation area on the third day after internal fixation were significantly lower than those on the first day after internal fixation, and the time of operation and the percutaneous unilateral solid pedicle were significantly lower than those on the first day after internal fixation. The average operation time of root nail fixation was 109 卤18min, and the average intraoperative bleeding was 60 卤16m LL4. There was no complication of nerve root injury after operation. The minimally invasive procedure for the treatment of single thoracolumbar fractures without spinal cord injury and severe disc injury was effective and safe. As a simple and easy method, the target fine needle guided puncture technique can significantly reduce the difficulty of transpedicular puncture, and has a very high success rate of single puncture.
【作者单位】：武汉市普仁医院骨一科;
【分类号】：R687.3

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