经皮椎弓根螺钉内固定结合伤椎置钉治疗胸腰椎骨折(1)
[摘要] 目的 探討经皮椎弓根螺钉内固定结合伤椎置钉在治疗胸腰椎骨折中的临床疗效。 方法 回顾性分析2014年9月～2016年11月共67例使用经皮椎弓根螺钉固定治疗的胸腰椎骨折患者，其中37例使用跨伤椎固定法(4钉组)，30例使用附加伤椎置钉法(6钉组)，观察两组手术切口长度、手术时间、术中出血量、术中透视次数、术后第1天伤口疼痛VAS评分，测量比较两组术前、术后、末次随访(>12个月)时节段Cobb角、伤椎前缘高度比值。 结果 所有患者随访12～23个月，平均(15.3±3.7)个月。与4钉组比较，6钉组手术切口更长、术中透视次数更多，且差异有统计学意义(P<0.05)。两组在手术时间、术中出血量、术后第1天伤口疼痛VAS评分方面比较，差异均无统计学意义(P>0.05)。与4钉组比较，6钉组术后节段Cobb角和末次随访节段Cobb角均更小，差异有统计学意义(P<0.05);6钉组术后伤椎前缘高度比值和末次随访伤椎前缘高度比值更大，差异有统计学意义(P<0.05)。 结论 经皮椎弓根钉固定术可以有效治疗胸腰椎骨折，加用伤椎置钉可以更好的纠正并维持胸腰段后凸角度。
[关键词] 经皮椎弓根钉;伤椎置钉;胸腰椎骨折;内固定术
[中图分类号] R687.3 [文献标识码] B [文章编号] 1673-9701(2019)32-0063-04
Clinical efficacy of percutaneous pedicle screw fixation combined with injured vertebrae screw fixation for thoracolumbar fractures
YU Yuanyang SHI Zongxin LIU Jianquan CHENG Tao XIA Xiaoyong DENG Jiechao CHEN Mengmeng
Department of Orthopaedics， Liangxiang Teaching Hospital， Capital Medical University， Beijing 102401， China
[Abstract] Objective To evaluate the clinical efficacy of percutaneous pedicle screw fixation combined with injured vertebrae screw fixation in the treatment of thoracolumbar fractures. Methods A total of 67 patients with thoracolumbar fractures treated with percutaneous pedicle screw fixation were retrospectively analyzed from September 2014 to November 2016. Among them， 37 patients were treated with trans-injured spine fixation(4-nail group) and 30 patients were treated with the injured vertebrae screw fixation(6-nail group). The length of the incision， the operation time， the intraoperative blood loss， the number of intraoperative fluoroscopy， and the degree of wound pain(VAS score) on the first postoperative day between two groups were observed. The ratio of the segment Cobb angle and the height of the injured vertebrae between preoperative， postoperative， and last follow-up(>12 months)was measured and compared. Results All patients were followed up for 12 to 23 months with an average of(15.3±3.7)months. Compared with that of the 4-nail group， the 6-nail group had longer incision， more intraoperative fluoroscopy， with statistical significance(P<0.05). There were no significant differences in the operation time， intraoperative blood loss， and postoperative wound pain VAS score between the two groups(P>0.05). Compared with that of the 4-nail group， the postoperative Cobb angle of the segment and the segment Cobb angle of the last follow-up in the 6-nail group was smaller， and the difference was statistically significant(P<0.05). The ratio of the height of the injured anterior border after surgery and during the last follow-up in the 6-nail group was larger， and the difference was statistically significant(P<0.05). Conclusion Percutaneous pedicle screw fixation can effectively treat thoracolumbar fractures. The use of injured vertebrae screw fixation can correct and maintain the kyphosis angle better., 百拇医药(于远洋 史宗新 刘建泉 程涛 夏效泳 邓介超 陈萌萌)
[关键词] 经皮椎弓根钉;伤椎置钉;胸腰椎骨折;内固定术
[中图分类号] R687.3 [文献标识码] B [文章编号] 1673-9701(2019)32-0063-04
Clinical efficacy of percutaneous pedicle screw fixation combined with injured vertebrae screw fixation for thoracolumbar fractures
YU Yuanyang SHI Zongxin LIU Jianquan CHENG Tao XIA Xiaoyong DENG Jiechao CHEN Mengmeng
Department of Orthopaedics， Liangxiang Teaching Hospital， Capital Medical University， Beijing 102401， China
[Abstract] Objective To evaluate the clinical efficacy of percutaneous pedicle screw fixation combined with injured vertebrae screw fixation in the treatment of thoracolumbar fractures. Methods A total of 67 patients with thoracolumbar fractures treated with percutaneous pedicle screw fixation were retrospectively analyzed from September 2014 to November 2016. Among them， 37 patients were treated with trans-injured spine fixation(4-nail group) and 30 patients were treated with the injured vertebrae screw fixation(6-nail group). The length of the incision， the operation time， the intraoperative blood loss， the number of intraoperative fluoroscopy， and the degree of wound pain(VAS score) on the first postoperative day between two groups were observed. The ratio of the segment Cobb angle and the height of the injured vertebrae between preoperative， postoperative， and last follow-up(>12 months)was measured and compared. Results All patients were followed up for 12 to 23 months with an average of(15.3±3.7)months. Compared with that of the 4-nail group， the 6-nail group had longer incision， more intraoperative fluoroscopy， with statistical significance(P<0.05). There were no significant differences in the operation time， intraoperative blood loss， and postoperative wound pain VAS score between the two groups(P>0.05). Compared with that of the 4-nail group， the postoperative Cobb angle of the segment and the segment Cobb angle of the last follow-up in the 6-nail group was smaller， and the difference was statistically significant(P<0.05). The ratio of the height of the injured anterior border after surgery and during the last follow-up in the 6-nail group was larger， and the difference was statistically significant(P<0.05). Conclusion Percutaneous pedicle screw fixation can effectively treat thoracolumbar fractures. The use of injured vertebrae screw fixation can correct and maintain the kyphosis angle better., 百拇医药(于远洋 史宗新 刘建泉 程涛 夏效泳 邓介超 陈萌萌)