胸腰段骨折微创手术疗效及术后局部镇痛效果观察

The effects of minimally invasive surgery for thoracolumbar fracture and local analgesia

目的评估胸腰段骨折微创手术疗效及术后局部镇痛的安全性及有效性。方法对19例无神经损伤的胸腰段骨折患者经皮行椎弓根螺钉固定治疗，记录手术时间、术中出血量。术后使用持续伤口镇痛装置进行局部镇痛处理，记录术后不同时间点疼痛视觉模拟评分（VAS）和并发症情况，随访治疗效果。结果手术时间65～110min，术中出血量50～108ml，无转为开放手术病例，无神经损伤及并发症发生。术后患者VAS值呈稳定状态，无镇痛不良反应及并发症出现。患者均获得随访，时间12～15个月。Cobb角：术前为16．4°±7．2°，术后为4．5°±1．0°，末次随访时为4．8°±1．5°，术后、末次随访时与术前比较差异均有统计学意义（P〈0．05）。结论经皮椎弓根螺钉内固定治疗无神经损伤胸腰段骨折安全有效，微创手术结合局部镇痛装置可以明显改善患者术后的疼痛。

Objective To evaluate the feasibility and safety of local analgesia device used in the surgery of percutaneous pedicle screw in the treatment of thoracolumbar fracture and study the effects of minimally invasive surgery for thoracolumbar fracture. Methods 19 thoracolumbar fractures patients without neurologic deficits were treated with the surgeries of percutaneous pedicle screw internal fixation. Operative time and intraoperative blood loss were recorded to observe clinical results. Local analgesia device was used in perioperative period. VAS and complications were recor- ded. Results The operation times were 65 - 110 rain, and the intraoperative blood losses were 50 - 108 ml. There were no conversions to open surgery, neurological deficits and other surgery-related complications. All patients were followed up for 12 ~ 15 months. Cobb angle was corrected from preoperative 16. 4°±7. 2° to postoperative 4. 5° ±1.0°, and 4. 8°± 1.5°at the final follow-up, all the differences were satistically significant （ P 〈 0. 05 ）. Conclusions Local analgesia device used in the surgery of percutaneous pedicle screw in the treatment of thoracolumbar fracture can be a safe and feasible method. Minimally invasive surgery and local analgesic improve patients＇ perioperative pain greatly.