短节段椎弓根内固定治疗屈曲牵张型胸腰椎骨折的护理

Nursing of thoracolumbar flexion-distraction fracture treated by short-segment pedicle screws

目的探讨短节段椎弓根螺钉内固定系统治疗屈曲牵张型胸腰椎骨折的护理要点。方法采取短节段椎弓根螺钉内固定系统治疗27例屈曲牵张型胸腰椎骨折患者，行术前护理、术后护理，并指导出院后的康复训练。术后通过放射学测量和Oswestry功能障碍指数功能评估综合评价其疗效。结果随访时间10个月～3．1年，平均2．8年，无手术并发症。伤椎前缘高度由术前平均70．6％±13．9％恢复至术后96．8％±5．4％（差异有统计学意义，P〈005），随访时95．2％±3．1％（与术后相比差异无统计学意义，P〉0．05）；Cobb角由术前平均（12．7±9．5）°恢复至术后（-1．9±8．1）°（差异有统计学意义，P〈0．05），随访时（-0．9±10．9）°（与术后相比差异无统计学意义，P〉0．05）。随访时患者Oswestry功能障碍指数平均为11．5（0～32）。结论屈曲牵张型胸腰椎骨折是一种不稳定性脊柱骨折，短节段椎弓根螺钉内固定系统治疗屈曲牵张型胸腰椎骨折可获得满意疗效，正确有效的护理措施是手术取得良好效果的保证。

Objective To investigate key nursing points of segmental pedicle screw instrumentation in the treatment of flexion- distraction thoracic and lumbar vertebral fractures. Methods Twenty- seven patients with flexion- distraction thoracic and lumbar vertebral fractures were treated with segmental pedicle screw instrumentation. Preoperative and postoperative nursing and rehabilitation training were conducted. Rehabilitation training guidance was provided after the patients were discharged from hospital. Radiology and the Oswestry Disability Index （ODI） wei-e used to evaluate the efficacy. Results All cases had no complications after having been followed up from 10 months to 3.1 years with a mean of 2.8 years. The anterior vertebral body height was reversed from preoperative 70.6% ± 13.9% to postoperative 96.8% ±5.4% （P（0.05）, at the follow- up 95.2 % ±3.1% （ P 〉0.05）. The Cobb＇ s angle was reversed from preoperative （ 12.7± 9.5 ）°to postoperative （ - 1.9 ± 8.1）° （P 〈 0.05）, at the follow - up （ - 0.9± 10.9）° （P 〉 0.05）. The mean ODI was 11.5 （0-32）. Conclusion Flexion- distraction fracture of thoracolumbar spine is an unstable spine fracture, and short- segment pedicle screw internal fixation system can obtain satisfactory effects. Correct effective nursing measures are the guarantee to any successful operation.