微创经伤椎椎弓根螺钉内固定联合植骨治疗胸腰椎骨折的临床观察

Minimally invasive internal fixation by pedicle screw through injury vertebra combined with bone graft in treatment of thoracolumbar vertebral fractures

目的探讨微创经伤椎椎弓根螺钉内固定联合植骨治疗胸腰椎骨折的临床疗效。方法选取我院2012年1月至2014年1月收治入院的200例胸腰椎骨折患者作为研究对象，按照随机数字表法分为观察组与对照组，各100例。对照组给予传统开放跨伤椎四钉椎弓根钉内固定术联合后外侧植骨融合术治疗，观察组给予微创经伤椎椎弓根植骨附加伤椎椎弓根螺钉内固定治疗，观察手术前后、两组患者的椎体矢状面指数、椎体Cobb’s角及椎体前缘高度。评估两组患者手术时间、手术切口长度、手术中出血量、手术后引流量及术后住院时间等指标，并进行统计学分析。结果观察组手术后影像学参数指标[矢状面指（1．8±7．0）。、Cobb’s角（4．1±3．4）。、椎体前缘高度变化（90．1±6．4）％]均明显优于对照组，两组比较差异有统计学意义（t=6．78、6．80、7．02，P〈0．05）；观察组手术时间、切口长度、术中出血量、术后引流量、术后住院时间分别为（142．0土14．3）min、（10．9±1．8）cm、（105．8±12．4）ml、（5．6±4．1）ml、（6．5±1．0）d，均明显优于对照组的（164．9±11．9）min、（16．1±1．6）cm、（506．1±101．4）ml、（386．8±87．8）ml、（9．6±2．7）d；两组比较差异有统计学意义（t=12．45、8．90、13．37、16．70、7．88，P〈0．05）。结论微创经伤椎椎弓根螺钉内固定联合植骨治疗胸腰椎骨折的疗效明显，且安全可靠。

Objective To investigate the clinical effect of minimally invasive internal fixation by pedicle screw through injury vertebra combined with bone graft in the treatment of thoracolumbar vertebral fractures. Methods 200 patients with thoracolumbar vertebral fractures admitted into our hospital from January, 2012 to January, 2014 were selected and randomly divided into an observation group and a control group, 100 cases for each group. The control group was treated with traditional open internal fixation by pedicle screw cross injury vertebra and posterior lateral bone grafting and fusion. The observation group was treated with minimally invasive vertebral pedicle bone grafting and internal fixation by pedicle screw through injury vertebra. The vertebral sagittal index, Cobb＇s angle, and the anterior height of vertebral body were observed before and after operation. The operation time, incision length, bleeding volume, postoperative drainage volume, postoperative hospital stay were evaluated in both groups. Results After the operation, the radiographic parameters [sagittal index （1.8±7.0）°, Cobb＇s angle （4.1±3.4）°, and vertebral height change （90.1±6.4）%] of the observation group were significantly better than those of the control group, with statistical differences （t = 6.78, 6.80, and 7.02, P〈0.05）. The operation time, incision length, bleeding volume, postoperative drainage volume, postoperative hospital stay were （142.0±14.3） rain, （ 10.9±1.8） cm, （ 105.8±12.4） ml, （5.6±4.1） ml, （6.54±1.0） d in the observation group and were （ 164.9±11.9） min, 06.1±1.6） cm, （506.1±101.4） ml, （386.8±87.8） ml, （9.6±2.7） d in the control group, with statisticaldifference （t = 12.45, 8.90, 13.37, 16.70, 7.88, P〈O.05）. Conclusions Minimally invasive internal fixation by pedicle screw through injury vertebra combined with bone graft in the treatment of thoracolumbar vertebral fractures is effective, safe, and reliable.