微创经皮椎弓根螺钉内固定治疗胸腰椎骨折的置钉选择

发布时间：2018-08-05 14:04

【摘要】：背景:单向椎弓根螺钉虽然在经皮椎弓根螺钉技术中有不利于安装的弱势,但其具有比万向椎弓根螺钉更佳的力学传导特性和稳定性,实践中如何选择和使用这2种螺钉,发挥各自优势,进一步提高疗效,已成为一个值得思考的课题。目的:比较单向与万向椎弓根螺钉不同置钉选择下,经皮椎弓根复位固定治疗胸腰椎骨折的临床疗效。方法:对46例无神经损伤症状的胸腰椎骨折患者采用微创经皮椎弓根螺钉复位内固定手术治疗,其中25例采用单向钉复位骨折固定(单向钉组),21例采用万向钉复位骨折固定(万向钉组)。比较内固定前后2组椎体前、后缘高度、伤椎后凸角、矫正率、丢失率等影像学指标,评价经皮单向钉和万向钉复位固定胸腰椎骨折的治疗效果。结果与结论:(1)2组在内固定时间、出血量、并发症以及住院时间等围术期资料差异无显著性意义(P0.05),(2)2组内固定后伤椎前、后缘高度百分比、伤椎后凸角度与内固定前比较,差异均有显著性意义(P0.05)。(3)内固定后单向螺钉组伤椎前缘高度百分比、伤椎后凸角度、矫正度优于万向螺钉组(P0.05),末次随访时丢失率优于万向螺钉组(P0.05),但内固定后伤椎后缘高度百分比差异无显著统计学差异(P0.05);(4)结果说明,与万向钉复位固定比较,应用单向钉椎弓根螺钉经皮微创复位、固定治疗胸腰椎骨折,更具有满意的骨折撑开复位疗效,后期矫形丢失更少。
[Abstract]:Background: although unidirectional pedicle screw has disadvantage to installation in percutaneous pedicle screw technology, it has better mechanical conduction characteristics and stability than universal pedicle screw. How to select and use these two kinds of screws in practice? Giving full play to their respective advantages and further improving the curative effect has become a topic worth thinking about. Objective: to compare the clinical effect of percutaneous pedicle reduction and fixation for thoracolumbar fractures with unidirectional and universal pedicle screws. Methods: 46 cases of thoracolumbar fractures without nerve injury were treated with minimally invasive percutaneous pedicle screw reduction and internal fixation. Among them, 25 cases were treated with unidirectional nail reduction fixation (unidirectional nail group) and 21 cases with common nail reduction and fixation (common nail group). The anterior and posterior edge height, kyphoid angle, correction rate and loss rate were compared between the two groups before and after internal fixation to evaluate the effect of reduction and fixation of thoracolumbar fractures with percutaneous unidirectional nail and universal nail. Results and conclusion: (1) there was no significant difference in perioperative data of internal fixation time, bleeding volume, complications and hospital stay between the two groups (P0.05), (2). The difference was significant (P0.05). (3). The percentage of anterior height and kyphosis angle of injured vertebrae in unilateral screw group after internal fixation were significantly higher than those in control group. The correction degree was better than the gimbal screw group (P0.05), the loss rate at the last follow-up was better than that of the gimbal screw group (P0.05), but there was no significant difference in the percentage of the posterior edge height of the injured vertebra after internal fixation (P0.05); (4). One-way screw pedicle screw was used to treat thoracolumbar fractures by percutaneous minimally invasive reduction.
【作者单位】：贵阳市第四人民医院(贵阳骨科医院)脊柱外科;
【分类号】：R318

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