摘要
目的比较微创椎弓根螺钉内固定术与传统开放手术对胸腰段脊柱骨折的临床效果,分析其对生活质量的影响。方法 2015年3月—2017年3月遂宁市中心医院脊柱外科收治122例胸腰椎段脊柱骨折患者,其中男性73例、女性49例,根据治疗方案将其分为开放组(61例)和微创组(61例),开放组患者行开放式椎弓根螺钉内固定术,微创组患者行经皮微创椎弓根螺钉内固定术。两组均采用经伤椎及伤椎上下椎椎弓根钉棒系统内固定。微创组:在C型臂透视下,经皮植入椎弓根钉;开放组:采用正中切口,肌间隙入路,显露横突与上关节突基底部中上1/3处植入椎弓根钉。比较两组手术一般情况、影像学参数、并发症和生活质量。结果微创组的切口总长度、术中出血量和术后引流量分别为(10.13±2.15)cm、(87.23±21.22)m L、(96.81±18.38)m L,明显少于开放组的(17.32±4.56)cm、(257.15±41.17)m L、(146.78±32.36)m L,两组比较差异有统计学意义(P<0.05)。两组术后椎体前缘高度、椎体矢状面指数和Cobb角均优于术前,但两组间比较差异无统计学意义(P>0.05)。微创组术后躯体疼痛程度得分、情绪角色评估得分、精神健康评估得分、总体健康评估得分高于同期开放组水平,两组比较差异有统计学意义(P<0.05)。结论微创经皮椎弓根螺钉内固定术治疗胸腰椎脊柱骨折,对患者创伤小,患者术后生活质量较高,值得临床推广应用。
Objective To compare the clinical effect of minimally invasive pedicle screw fixation and traditional open surgery in treatment of thoracolumbar spine fracture,and to analyze their influence on quality of life.Methods From Mar. 2015 to Mar. 2017,122 patients with thoracolumbar vertebral fractures,including 73 males and 49 females,were divided into open group（ 61 cases） and minimally invasive group（ 61 cases）. Open pedicle screw internal fixation was performed in the open group,and minimally invasive pedicle screw internal fixation was performed in the minimally invasive group. The internal fixation was performed through the vertebral pedicle screw system of the injured vertebrae via the injured vertebrae in both groups. Minimally invasive group： pedicle screws were percutaneously implanted under C-arm fluoroscopy; open group： median incision and intermuscular approach were applied,and processus transverses and vertebral arch in the upper third of the base of the transverse process were exposed to implant the pedicle screw. The general conditions,imaging parameters,complications and quality of life of the two groups were compared. Results Total incision length,intraoperative blood loss and postoperative drainage in minimally invasive group were（ 10. 13 ± 2. 15） cm,（ 87. 23 ± 21. 22） m L,（ 96. 81 ± 18. 38） m L,respectively,which were significantly less than those in open group（（ 17. 32 ± 4. 56） cm,（ 257. 15 ± 41. 17） m L,（ 146. 78± 32. 36） m L）,and there were significant differences between the two groups（ P 0. 05）. Vertebral anterior height,vertebral sagittal index and Cobb＇s angle after operation in both groups got better compared with pre-operation,but no significant difference was observed between the two groups（ P 0. 05）. After operation,limb pain score,emotional role assessment score,mental health assessment score,and overall health assessment score in the minimally invasive group were significantly higher than those in the open group（ P 0. 05）. Conclusion Minimally invasive percutaneous pedicle screw fixation for the treatment of thoracolumbar spine fractures is less traumatic and the patients,quality of life is high. It is worthy of clinical application.
作者
陈宇
郑佳状
汪凡栋
刘元彬
廖伟
张娜
张智
CHEN Yu;ZHENG Jia-zhuang;WANG Fan-dong;LIU Y-uan-bin;LIAO Wei;ZHANG Na;ZHANG Zhi(Department of Spine Surgery-,Suining Central Hospital,Suining,Sichuan 629000,China)
出处
《创伤外科杂志》
2018年第9期689-692,共4页
Journal of Traumatic Surgery
关键词
胸腰段脊柱骨折
椎弓根螺钉
内固定术
微创
thoracolumbar spine fracture
pedicle screw
internal fixation
minimally invasive
