经皮伤椎终板撬拨复位联合短节段椎弓根螺钉内固定治疗胸腰椎骨折的临床观察

发布时间：2018-09-03 18:49

【摘要】：目的探讨经皮伤椎终板撬拨复位联合短节段椎弓根螺钉内固定治疗胸腰椎骨折的临床疗效。方法选择胸腰椎骨折患者68例,随机分为观察组36例和对照组32例。观察组采用经皮伤椎终板撬拨复位联合短节段椎弓根螺钉内固定治疗,对照组采用经皮短节段椎弓根螺钉内固定治疗。记录两组术中出血量、手术时间;术前及术后1、3、7天采用酶分析法检测血清肌酸激酶;术前、术后1周、术后12个月记录疼痛视觉模拟评分(VAS)并行胸腰椎X线检查,计算伤椎前缘高度比、伤椎终板高度比。结果观察组与对照组术中出血量分别为(65.6±33.0)、(52.7±13.0)m L,手术时间分别为(107.9±10.2)、(83.9±9.5)min;两组比较P均0.05。两组术后1、3天血清肌酸激酶水平均高于同组术前(P均0.01),术后7天血清肌酸激酶水平与同组术前比较差异均无统计学意义(P均0.05)。两组间手术前后各时间点血清肌酸激酶水平比较差异均无统计学意义(P均0.05)。两组术后1周、术后12个月VAS均低于术前,且术后12个月降低更明显(P0.05或0.01)。两组术后1周、术后12个月伤椎前缘高度比、伤椎终板高度比均高于同组术前(P均0.01)。观察组术后12个月伤椎前缘高度比、伤椎终板高度比均高于对照组,VAS低于对照组(P均0.05)。结论与经皮短节段椎弓根螺钉内固定比较,经皮伤椎终板撬拨复位联合短节段内固定术治疗胸腰椎骨折可更大程度地恢复脊柱生理曲度及伤椎完整性,减轻椎旁肌损伤及腰背部疼痛。
[Abstract]:Objective to investigate the clinical effect of percutaneous disc prying reduction combined with short segment pedicle screw fixation in the treatment of thoracolumbar fractures. Methods Sixty-eight patients with thoracolumbar fracture were randomly divided into observation group (n = 36) and control group (n = 32). The observation group was treated with percutaneous reduction of end plate and short segment pedicle screw fixation, while the control group was treated with percutaneous short segment pedicle screw fixation. Serum creatine kinase was detected by enzyme analysis before and 1 day after operation, and visual analogue score of pain (VAS) and thoracolumbar spine X-ray examination were recorded 1 week and 12 months after operation. The anterior height ratio of injured vertebrae and the ratio of end plate height of injured vertebra were calculated. Results the amount of intraoperative bleeding was (65.6 卤33.0), () 52.7 卤13.0) m L, in the observation group and (107.9 卤10.2), (83.9 卤9.5) min; in the control group (P < 0.05). The level of serum creatine kinase in the two groups was significantly higher than that in the same group on the 3rd day after operation (P 0.01), but there was no significant difference between the two groups on the 7th day after operation compared with the same group (P 0.05). There was no significant difference in serum creatine kinase levels between the two groups before and after operation (P 0.05). The VAS in both groups was lower than that before operation at 1 week and 12 months after operation, and the decrease was more significant at 12 months after operation (P0.05 or 0.01). At 1 week and 12 months after operation, the ratio of anterior height and end plate height of injured vertebrae in both groups was higher than that in the same group (P 0.01). At 12 months after operation, the ratio of anterior height and end plate height of injured vertebrae in the observation group was higher than that in the control group (P 0.05). Conclusion compared with percutaneous short segment pedicle screw internal fixation, the treatment of thoracolumbar fractures with percutaneous disc prying reduction combined with short segment internal fixation can recover the physiological curvature of spine and the integrity of injured vertebrae to a greater extent. Relieve paravertebral muscle injury and back pain.
【作者单位】：临沂市中心医院;
【基金】：临沂市科技发展计划项目(201515034)
【分类号】：R687.3

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