胸腰段骨折短节段椎弓根钉内固定治疗-经伤椎与跨伤椎的临床疗效分析

发布时间：2018-09-18 13:40

【摘要】：目的:比较分析经伤椎置钉固定与跨伤椎固定在胸腰段骨折治疗中的临床疗效。方法:回顾性分析2014年12月至2016年1月期间我院收治的62例胸腰段骨折患者的临床资料,按内固定方式进行随机分组,其中以27例经伤椎椎弓根固定作为实验组,35例跨伤椎椎弓根固定作为对照组,对两组患者性别、年龄、损伤节段、受伤原因等一般资料进行数据相关统计分析,差异无显著性意义(P0.05),具有可比性。比较两组患者手术时间、术中出血、术后输血、住院天数及并发症(切口感染、腰背部疼痛及内固定松动、断裂等)的发生情况。两组患者术后均随访1--2年,对并发症的发生情况以及伤椎Cobb角、伤椎前缘高度比进行长期随访评价。结果:1两组患者在手术及住院治疗过程中,经伤椎组与跨伤椎组在手术时间、术中出血、术中输血及住院时间方面,差异无显著性意义(P0.05)。2 Cobb角和伤椎前缘高度方面,两组在治疗前差异未见显著性意义,而在治疗后及随访丢失方面,经伤椎组优于跨伤椎组,差异具有统计学意义(P0.05)。3在疼痛视觉模拟评分方面,两组组间比较,治疗前、治疗后差异均无显著性意义,而经伤椎组在末次随访时要优于跨伤椎组,差异有显著性意义(P0.05)。4统计结果提示经长期随访两种手术方式均能较为有效的复位固定伤椎,可较好的矫正损伤后脊柱畸形,缓解疼痛症状,改善、恢复患者的功能。与跨伤椎组相比,经伤椎组在恢复和维持脊柱的高度和曲度方面优势更加明显,可更加有效的重建脊柱生理序列并维持其稳定性,修复后腰背痛也可以得到有效控制。结论:与传统跨伤椎固定相比,经伤椎椎弓根螺钉固定术能更好的重建脊柱稳定,恢复及维持伤椎前缘高度和生理曲度,是治疗胸腰段骨折一种安全有效的手术方法。
[Abstract]:Objective: to compare and analyze the clinical results of thoracolumbar fractures treated by transthoracic screw fixation and transthoracic spinal screw fixation. Methods: the clinical data of 62 patients with thoracolumbar fracture treated in our hospital from December 2014 to January 2016 were retrospectively analyzed. Among them, 27 cases of pedicle fixation of injured vertebrae were used as experimental group and 35 cases of transpedicular fixation as control group. The data of sex, age, injury segment and injury cause of patients in the two groups were statistically analyzed. There was no significant difference (P0.05), which was comparable. The time of operation, intraoperative bleeding, postoperative blood transfusion, hospital stay and complications (incision infection, back pain, loosening of internal fixation and breakage) were compared between the two groups. The patients in both groups were followed up for 1 to 2 years. The incidence of complications, the Cobb angle of injured vertebra and the ratio of anterior height of injured vertebrae were evaluated for a long time. Results there was no significant difference in operative time, intraoperative bleeding, intraoperative blood transfusion and hospital stay between the two groups during operation and hospitalization (P0.05). There was no significant difference in the angle of 2. 2 Cobb and the height of the anterior edge of the injured vertebra between the two groups (P0.05), and there was no significant difference between the two groups in terms of operation time, intraoperative bleeding, intraoperative blood transfusion and hospitalization time. There was no significant difference between the two groups before treatment, but in the loss after treatment and follow-up, the injured vertebra group was better than the cross-injured vertebra group. The difference was statistically significant (P0.05) in the visual analogue score of pain. There was no significant difference between the two groups after treatment, but the last follow-up was better in the injured vertebra group than in the cross-injured vertebra group, and the difference was significant (P0.05). The statistical results showed that the two kinds of surgical methods were effective in reduction and fixation of the injured vertebrae after long-term follow-up. It can correct spinal deformity after injury, relieve pain, improve and recover patients' function. Compared with the trans-injured vertebra group, the injured vertebra group has more obvious advantages in restoring and maintaining the height and curvature of the spine, which can effectively reconstruct the physiological sequence of the spine and maintain its stability, and can also be effectively controlled after the repair of low back pain. Conclusion: compared with the traditional transpedicular screw fixation, transpedicular screw fixation is a safe and effective method for the treatment of thoracolumbar fractures. It can reconstruct spinal stability, restore and maintain the anterior height and physiological curvature of the injured vertebrae, and is a safe and effective method for the treatment of thoracolumbar fractures.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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