自制脊柱定位尺和经皮椎弓根钉棒固定系统治疗胸腰椎骨折的应用

Exploration of therapeutic effect and value of the self-made spinal positioning equipment and percutaneous pedicle screw fixation system in the treatment of thoracic and lumbar fractures

目的 探讨自行研制的脊柱定位尺和经皮椎弓根钉棒固定系统治疗胸腰椎骨折的疗效及应用价值.方法 利用脊柱定位尺确定伤椎和椎弓根进钉点,应用经皮椎弓根钉棒固定系统对67例胸腰椎骨折患者实施经皮椎弓根钉棒固定术,通过与52例开放手术比较定位时间、准确率、手术时间、切口大小、术中出血量等临床指标,以及手术前后椎体高度、后凸Cobb角、椎管狭窄（椎管矢状径）等影像学指标评价该系统的治疗效果及应用价值.结果 脊柱定位尺定位时间（15.85±2.45）min、透视次数（7.16±1.34）次、定位准确率95.03%±3.27%,而开放手术此三项指标分别为（35.46±5.39）min、（12.04±3.36）次、94.02%±2.95%.两种方法 定位准确率比较差异无统计学意义,而定位时间和透视次数比较差异有统计学意义.经皮椎弓根钉棒固定系统在恢复胸腰椎压缩椎体高度、纠正后凸成角和椎管缩窄等方面与开放手术内固定具有同样的效果,两组手术前后影像指标差异均有统计学意义.经皮椎弓根钉棒内固定手术时间（70.00±7.20）min,切口长度（8.50±0.95）cm,术中出血量（50.00±6.20）ml,术后引流量（20.00±5.20）ml,住院天数（4.49±0.70）d,住院费用（7841.6±128.3）元,术后实施镇痛1例,与开放手术相比,各项临床指标比较差异均有统计学意义.结论 脊柱定位尺可快速、有效确定伤椎和椎弓根钉进针点,减少射线辐射.经皮椎弓根钉棒固定系统设计合理,置入椎弓根钉和连接棒完全经皮操作,准确性高,创伤小,术后反应轻,恢复快,并发症少,为胸腰椎骨折患者提供了一种新的微创治疗方法.

Objective To explore the therapeutic effect and application value of the self-made spinal positioning equipment and percutaneous pedicle screw fixation system in the treatment of thoracic and lumbar fracture. Methods To determine the fractured vertebra and pedicle screws entrance point with spinal positioning equipment, 67 patients with thoracic and lumbar fractures were performed percutaneous pedicle screw fixation by using self-made percutaneous pedicle screw fixation system. By contrasting the perioperative indicators, and imaging indicators, to evaluate the therapeutic effect and application value of the system. Results For the spinal positioning equipment, the location time were （15.85±2.45） min and the location accuracy were 95.03%±3.27%. But for the open reduction internal fixation, the location time were （35.46±5.39） min and the location accuracy were 94.02%±2.95%. There was no significant difference in location accuracy, but were significant differences in location time （P〈0.05）. Percutaneous pedicle screw fixation had the same effect on three sides with open reduction internal fixation in vertebral height restore,kyphosis deformity and correction and lumbar spinal stenosis＇s correction. The perioperative indicators of the preoperative and postoperative grope had significant difference （P〈0.05）. There were significant differences in all perioperative indicators between the percutaneous pedicle screw fixation and the open reduction internal fixation （P〈0.05）. Conclusion The spinal positioning equipment is helpful to determine the fractured vertebra and pedicle screws entrance point accurately and reduce the radiation. The percutaneous pedicle screw fixation system has the advantage of convenient manipulation and accurate implantation. The system can not only reduce surgical damage and post-operation reaction but also make patients recover quickly and face less complications.