经椎旁肌间隙入路单、双运动单元固定治疗胸腰椎骨折（AO分型A1型）的疗效分析
发布时间：2019-03-06 13:25
【摘要】：目的:对比经肌间隙入路单运动单元椎弓根钉内固定与经伤椎双运动单元椎弓根钉内固定治疗A1型胸腰椎骨折(AO分型A1型)的临床疗效。方法:回顾性分析2010年1月至2015年1月采用经椎旁肌间隙入路单运动单元和经伤椎双运动单元椎弓根钉固定治疗胸腰段单一椎体骨折(AO分型A1型)80例患者的临床资料,其中男性患者46例,女性患者34例,年龄在22岁至60岁之间,平均年龄38.8岁。按运动单元固定不同分为单运动单元固定组36例和双运动单元固定组44例,所有患者均采取手术治疗且手术入路相同,均为经后路椎旁肌间隙入路。记录并测量两组患者的手术时间、出血量,术前、术后3天及术后1年伤椎其上下相邻正常椎体的前缘高度以及矢状面Cobb角。对统计数据运用SPSS17.0软件进行统计学处理,分析比较两种手术方式的差异。结果:80例A1型胸腰椎骨折手术治疗均取得成功,术后无严重并发症发生。全部病例在术后均进行随访。单运动单元固定组36例,手术时间为(75.34±10.17)min,手术出血量为(206.23±25.43)ml,双运动单元固定组44例,手术时间为(115.57±13.53)min,手术出血量为(230.32±32.34)ml,双运动单元组的手术时间及手术出血量均高于单运动单元固定组,差异均有统计学意义(P0.05),术前单运动单元固定组椎体压缩率为44.56%±4.5%,双运动单元固定组椎体压缩率为45.53±8.2%,Cobb角分别为24.5°±4.1°、25.7°±5.6°,术后第3天两组椎体的压缩率分别为9.33%±5.3%、8.69%±5.4%,cobb角分别为9.3°±1.5°、8.9°±3.2°,差异无统计学意义(P0.05),一年后随访时单、双运动单元组椎体压缩率分别为11.83%±4.1%、10.13%±2.6%,Cobb角分别为10.1°±1.5°、9.9°±3.1°,差异无统计学意义;与术后第三天统计数据相比,差异仍无统计学意义。结论:对于A1型胸腰椎骨折而言,Wiltse肌间隙入路单、双运动单元经伤椎椎弓根钉内固定均可有效缓解疼痛、恢复伤椎椎体前缘高度及Cobb角,但单运动单元固定具有手术操作简单、手术时间短、出血量少等优点,更重要的是增加椎体活动度并减少对邻近椎体的影响,有较好的推广应用价值。
[Abstract]:Aim: to compare the clinical effects of single motor unit pedicle screw fixation via muscle space approach and double motor unit pedicle screw fixation through injured vertebrae in the treatment of type A1 thoracolumbar fracture (AO type A1). Methods: from January 2010 to January 2015, 80 patients with thoracolumbar single vertebral fracture (AO type A1) were treated with single motor unit through paravertebral intermuscular space and pedicle screw fixation with double motor unit through injured vertebrae, and the clinical data of 80 patients with thoracolumbar fracture (type A1) were analyzed retrospectively. There were 46 males and 34 females, aged from 22 to 60, with an average age of 38.8 years. According to the different fixation of motor unit, 36 cases of single motor unit fixation group and 44 cases of double motor unit fixation group were divided into two groups. All the patients were treated by operation and the approach was the same, all of them were through posterior paravertebral intermuscular space approach. The operation time, bleeding volume, anterior height and sagittal Cobb angle of the upper and lower adjacent normal vertebrae of the injured vertebrae were recorded and measured before, 3 days after operation and 1 year after operation. The statistical data were processed by SPSS17.0 software, and the differences between the two surgical methods were analyzed and compared. Results: all 80 cases of A 1 type thoracolumbar fracture were successfully treated, and no serious complications occurred after operation. All cases were followed up after operation. The operation time was (75.34 卤10.17) min, the bleeding volume was (206.23 卤25.43) ml, in the double motor unit fixation group, and the operative time was (115.57 卤13.53) min, in the double motor unit fixation group (n = 44). The operative bleeding volume was (230.32 卤32.34) ml, double motor unit group's operation time and operation bleeding volume were higher than that of single motor unit fixation group, the difference was statistically significant (P0.05). The vertebral compression rate was 44.56% 卤4.5% in the single motor unit fixation group, 45.53 卤8.2% in the double motor unit fixation group, and 24.5 掳卤4.1 掳and 25.7 掳卤5.6 掳in the double motor unit fixation group, respectively, and the Cobb angle was 24.5 掳卤4.1 掳and 25.7 掳卤5.6 掳, respectively. The compression rate was 9.33% 卤5.3%, 8.69% 卤5.4%, and the Cobb angle was 9.3 掳卤1.5 掳and 8.9 掳卤3.2 掳, respectively. There was no significant difference between the two groups on the 3rd day after operation (P0.05). The vertebral compression rates were 11.83% 卤4.1%, 10.13% 卤2.6%, and Cobb angles were 10.1 掳卤1.5 掳and 9.9 掳卤3.1 掳in the dual motor unit group, respectively. There was no significant difference between the two groups (P < 0.05). Compared with the statistical data on the third day after operation, the difference was still not statistically significant. Conclusion: for type A1 thoracolumbar fractures, the single approach of Wiltse muscle space and internal fixation of double motor units through pedicle screw can effectively relieve pain and restore the height of anterior edge and Cobb angle of injured vertebrae. However, single motor unit fixation has the advantages of simple operation, short operation time and less bleeding. It is more important to increase the degree of vertebral body movement and reduce the influence on the adjacent vertebral body, which has a good value of popularization and application.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R687.3
[Abstract]:Aim: to compare the clinical effects of single motor unit pedicle screw fixation via muscle space approach and double motor unit pedicle screw fixation through injured vertebrae in the treatment of type A1 thoracolumbar fracture (AO type A1). Methods: from January 2010 to January 2015, 80 patients with thoracolumbar single vertebral fracture (AO type A1) were treated with single motor unit through paravertebral intermuscular space and pedicle screw fixation with double motor unit through injured vertebrae, and the clinical data of 80 patients with thoracolumbar fracture (type A1) were analyzed retrospectively. There were 46 males and 34 females, aged from 22 to 60, with an average age of 38.8 years. According to the different fixation of motor unit, 36 cases of single motor unit fixation group and 44 cases of double motor unit fixation group were divided into two groups. All the patients were treated by operation and the approach was the same, all of them were through posterior paravertebral intermuscular space approach. The operation time, bleeding volume, anterior height and sagittal Cobb angle of the upper and lower adjacent normal vertebrae of the injured vertebrae were recorded and measured before, 3 days after operation and 1 year after operation. The statistical data were processed by SPSS17.0 software, and the differences between the two surgical methods were analyzed and compared. Results: all 80 cases of A 1 type thoracolumbar fracture were successfully treated, and no serious complications occurred after operation. All cases were followed up after operation. The operation time was (75.34 卤10.17) min, the bleeding volume was (206.23 卤25.43) ml, in the double motor unit fixation group, and the operative time was (115.57 卤13.53) min, in the double motor unit fixation group (n = 44). The operative bleeding volume was (230.32 卤32.34) ml, double motor unit group's operation time and operation bleeding volume were higher than that of single motor unit fixation group, the difference was statistically significant (P0.05). The vertebral compression rate was 44.56% 卤4.5% in the single motor unit fixation group, 45.53 卤8.2% in the double motor unit fixation group, and 24.5 掳卤4.1 掳and 25.7 掳卤5.6 掳in the double motor unit fixation group, respectively, and the Cobb angle was 24.5 掳卤4.1 掳and 25.7 掳卤5.6 掳, respectively. The compression rate was 9.33% 卤5.3%, 8.69% 卤5.4%, and the Cobb angle was 9.3 掳卤1.5 掳and 8.9 掳卤3.2 掳, respectively. There was no significant difference between the two groups on the 3rd day after operation (P0.05). The vertebral compression rates were 11.83% 卤4.1%, 10.13% 卤2.6%, and Cobb angles were 10.1 掳卤1.5 掳and 9.9 掳卤3.1 掳in the dual motor unit group, respectively. There was no significant difference between the two groups (P < 0.05). Compared with the statistical data on the third day after operation, the difference was still not statistically significant. Conclusion: for type A1 thoracolumbar fractures, the single approach of Wiltse muscle space and internal fixation of double motor units through pedicle screw can effectively relieve pain and restore the height of anterior edge and Cobb angle of injured vertebrae. However, single motor unit fixation has the advantages of simple operation, short operation time and less bleeding. It is more important to increase the degree of vertebral body movement and reduce the influence on the adjacent vertebral body, which has a good value of popularization and application.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R687.3
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