经伤椎椎弓根螺钉置入内固定治疗无神经损伤胸腰椎骨折的临床研究

The clinical study of fixation vertebral pedicle screw in the treatment of thoracolumbar fractures without nerve injury patients

目的：探讨经伤椎椎弓根螺钉置入内固定对无神经损伤胸腰椎骨折的临床疗效，为治疗提供指导和帮助。方法选取无神经损伤的胸腰椎骨折患者76例，采用随机数表法分为观察组和对照组，每组38例。观察组采用经伤椎椎弓根螺钉置入内固定技术治疗，对照组采取跨伤椎固定技术治疗。对患者手术前、手术后1周、手术后3个月、手术后12个月进行随访，比较围手术期参数、影像学指标、视觉模拟评分法（VAS）及腰背功能障碍指数（ODI）。结果围手术期参数对比和椎弓根螺钉置入准确率差异无统计学意义；两组术前 VAS、ODI、Vobb 角和伤椎前缘高度比差异无统计学意义。术后12个月观察组 ODI 评分为（10．3±2．8）分，明显低于对照组的（13．5±2．5）分，差异有统计学意义（t ＝3．287，P ＜0．05），此外观察组在 VAS、术后 Cobb 角以及伤椎椎体前缘高度的恢复程度与对照组比较，差异均有统计学意义（P ＜0.05）。结论经伤椎椎弓根螺钉置入内固定治疗无神经损伤胸腰椎骨折的疗效突出，伤椎椎体高度恢复良好，并发症少，安全性可靠，值得在临床上推广应用。

Objective To evaluate the clinical efficacy of vertebral pedicle screw internal fixation for thora-columbar fractures without neurological damage,and to provide guidance and assistance for the treatment.Methods The thoracolumbar fracture patients during our inpatient treatment without neurological damage clinical data of 76 cases were selected,patients were randomly assigned into the observation group and the control group,each within 38 cases. The observation group were treated by vertebral pedicle screw fixation technique in the treatment and control group for cross -vertebral fixation treatment.Patients before surgery,one week after surgery,three months after surgery and 12 months after surgery were followed up,and the perioperative parameters,radiographic parameters,visual analog scale （VAS）and back disability index （ODI）were compared.Results Perioperative parameter comparison and difference of the accuracy of pedicle screw no significant showed no statistically significance.Preoperative VAS,ODI, Vobb angle and vertebral anterior height ratio in the two groups showed no significant difference.After 12 months of observation group ODI score was （10.3 ±2.8）points,which was significantly lower than that （13.5 ±2.5）points in the control group,the difference was statistically significant （t =3.287,P 〈0.05）.In addition,the observer group in VAS,surgery after Cobb angle and vertebral degree of restoration of vertebral height compared with control group,the differences were statistically significant （all P 〈0.05）.Conclusion By using vertebral pedicle screw fixation for the treatment of thoracolumbar fractures without neurological damage shows efficacy,good prominent vertebral body height restoration,fewer complications,safety and reliable,which is worthy of clinical application.