胸腰椎段脊柱骨折经皮椎弓根螺钉固定术的效果

EFFECT OF PERCUTANEOUS PEDICLE SCREW FIXATION FOR THORACOLUMBAR SPINAL FRACTURE

目的探讨胸腰椎段脊柱骨折经皮椎弓跟螺钉固定术的效果。方法选择2011年7月—2013年7月该院收治的96例胸腰段脊柱骨折的患者作为观察对象,随机分为经皮组和开放组,各48例,观察二组患者术后1、3、7和10d肌肉受损指标肌酸激酶变化、患者手术前后影像学参数和二组患者术后情况。结果从术后3d开始,二组患者肌酸激酶水平均较术后1d显著下降,且经皮组术后3、7、10d肌酸激酶水平显著低于开放组,差异具有统计学意义(P<0.05);术前,二组的椎体前缘高度比值和后凸Cobb'角无明显差异(P>0.05),术后,二组椎体前缘高度比值和后凸Cobb'角均较术前改善明显,差异均具有统计学意义(P<0.05),但组间比较差异无统计学意义(P>0.05);经皮组的手术时间、术中出血量、术后下床时间和住院时间明显短于开放组,差异具有统计学意义(P<0.05)。结论胸腰椎段脊柱骨折运用经皮椎弓根螺钉固定术治疗是安全有效的,手术创伤小,术中出血量少,术后恢复快,值得临床推广。

Objective To investigate the effect of percutaneous pedicle screw fixation in the treatment of thoracolumbar spinal fracture .Methods Totally 96 cases of thoracolumbar spinal fracture patients were treated from July 2011 to July 2013 in author＇s hospital ,they were randomly divided into the percutaneous group and open group ,48 cases in each group .The change of creatine kinase ,muscle damage indices ,and imaging parameters and postoperative situation were compared in two groups after operation for 1d ,3d ,7d and 10d .Results Compared after first day ,the creatine kinase levels in the two groups patients were sig-nificantly decreased from the third day after operation ,and the creatine kinase level was also significantly lower in the percutaneous group than the open group after operation for 3d ,7d and 10d ,the difference was statistically significant （P〈0 .05） .Before operation ,the ratio of anterior vertebral height and kyphosis and Cobb＇angle had no significant difference in both groups（P〉0 .05） ,compared before operation ,they were improved significantly in postoperative ,the differences were statistically significant （P〈0 .05） ,but no difference between the two groups （P〉0 .05） .The operation time ,intraoperative bleeding volume , postoperative ambulation time and hospitalization time were shorter in the percutaneous group than the open group ,the difference was statistically significant （P〈0 .05） .Conclusion Thoracolumbar spinal fracture with percutaneous pedicle screw fixation is a safe and effective operation with small trauma ,less bleeding and faster postoperative recovery .It is worthy the clinical promotion .