经皮单向长尾椎弓根螺钉内固定治疗单节段胸腰椎骨折

Percutaneous one-way long tail pedicle screw internal fixation treatment thoracolumbar spine fractures single section

目的 探讨经皮单向椎弓根螺钉治疗脊柱骨折手术与传统开放手术的疗效对比.方法 对2012年10月-2014年10月收集61例单节段胸腰椎骨折患者进行回顾性分析,分别对经皮微创单向椎弓根螺钉内固定（观察组,n =32）和常规开放切开内固定（对照组,n=29）进行对比.比较两组患者在手术时间、手术出血量、手术创面、术后VAS评分、术后伤椎前缘高度比值及住院费用等方面的差异性.结果 所有患者术后均获得7 ～14个月（平均9.6个月）的随访,两组均未出现内固定相关并发症.手术时间：观察组（87.4±13.6） min、对照组（92.3±10.3） min,（t=-1.648,P＞0.05）;手术出血量：观察组（73±8.8） mL、对照组（352 ±63.7） mL,（t=-23.385,P＜0.05）;手术创面：观察组（12.3 ±2.30） cm2、对照组（81.5±14.2） cm2,（t=-25.937,P＜0.05）;住院费用（万元）：观察组（3.5±0.3）万元、对照组（2.3±0.5）万元,（t=-11.223,P＜0.05）.术后2天及6个月VAS评分：观察组（3.0±0.4）及（1.3±0.6）、对照组（4.2±0.5）及（2.7±0.7）,（t=-10.396及-8.409,P＜0.05）,并且与术前相比同样具有统计学意义（P＜0.05）;术后2天及6个月伤椎前缘高度比值：观察组（89.6±7.2）％及（84.2±5.7）％、对照组（91.3±5.8）％及（86.3±4.6）％,（t=-1.009及-1.573,P＞0.05）,但同组内术前术后相比伤椎前缘高度比值均显著恢复有统计学意义（P＜0.05）.结论 对于单节段胸腰椎脊柱骨折,与传统开放手术相比,经皮单向长尾椎弓根螺钉内固定技术具有创伤小、后遗症少、术后恢复快等优势,并且在椎体高度的恢复及后期的丢失方面取得了同样的疗效,但患者花费较大.

Objective Explore the spine fractures treated by percutaneous one-way pedicle screws surgery compared with curative effect of traditional open surgery.Methods From October 2012 to October 2015,to collect 61 patients with single segmental thoracolumbar fractures were retrospectively analyzed,respectively for percutaneous minimally invasive one-way long tail pedicle screw（Observation group,n =32） of internal fixation were compared with traditional open surgery （control group,n =29）.Compare two groups of paticnts in the differences of operation time,amount of operative bleeding,operative wound,postoperative VAS scores,the ratio of postoperative injured vertebral front height,and hospitalization expenses.Results All patients were followed up for an average of 9.6 months （from 7 to 14months）,neither of the groups showed internal fixation of related complications.Time of operation（min）：observation group（87.4 ± 13.6） min,control group （92.3 ± 10.3） min,（t =-1.648,P 〉 0.05）;Mount of operative bleeding：observation group （73 ± 8.8） mL,control group （352 ± 63.7） mL,（t =-23,385,P 〈 0.05）;Wound of operative （cm2）：observation group （12.3 ± 2.30） cm2,control group （81.5 ± 14.2） cm2,（t =-25.937,P 〈 0.05）;Expenses of hospitalization （RMB ten thousand）：observation group （3.5 ± 0.3）,control group（2.3± 0.5）,（t =-11.223,P 〈 0.05）;VAS score 2 days and 6 months after surgery：observation group （3.0±0.4） and （1.3±0.6）,controlgroup（4.2±0.5） and （2.7±0.7）,（t=-10.396 and-8.409,P〈 0.05）,and comparcd with the preoperative also statistically significant （P 〈 0.05）;2 days and 6 months after surgery in the ratio of injured vertebral front height：observation group（89.6 ±7.2）% and （84.2 ±5.7）%,control group （91.3 ± 5.8） % and （86.3 ± 4.6） %,（t =-1.009 and-1.573,P 〉 0.05）,but in the same group recovery of injured vertebral leading edge height ratio compared with preoperative postoperative were significantly （P 〈 0.05）.Conclusion For a single section of thoracolumbar spine fracture,Compared with the control group,Percutaneous one-way long tail pedicle screw internal fixation technology have the advantage of little trauma,less sequel,rapid postoperative recovery,also in the recovery of vertebral body height and loss of late has achieved the same cur-ative effect,but patients with costly.