经皮椎弓根内固定配合手法闭合复位治疗胸腰段脊柱骨折的可行性

Analysis of feasibility of percutaneous pedicle fixation combined with closed manipulative reduction in the treatment of thoracolumbar spinal fractures

目的研究经皮椎弓根内固定和手法闭合复位联合治疗胸腰段脊柱骨折的效果。方法选择2014年3月～2016年1月在我院接受治疗的40例胸腰段脊柱骨折患者,按随机数字表法将其分为观察组和对照组,每组20例,对照组患者采用经皮椎弓根内固定术进行治疗,观察组则在经皮椎弓根内治疗的基础上配合手法闭合复位进行治疗。比较两组患者的临床疗效、影像学参数、VAS评分及术后并发症发生率。结果观察组患者的切口长度、出血量、引流量、手术时间、住院时间等各项指标明显优于对照组,差异有统计学意义（P〈0.01）;两组患者的影像学参数比较,差异无统计学意义（P〉0.05）;术后1、3 d,观察组患者的VAS评分均低于对照组,差异有统计学意义（t=3.8334、2.4901,P〈0.05）。术后,对照组患者中出现1例下肢深静脉血栓,观察组中未出现,除此之外,两组患者均未出现其他严重并发症。结论经皮椎弓根内固定联合手法闭合复位治疗胸腰椎骨折能明显改善治疗的临床效果,降低患者的VAS评分,减少手术过程中的创伤,值得在临床上推广应用。

Objective To study the effect of percutaneous pedicle fixation combined with closed manipulative reduction in the treatment of thoracolumbar spinal fractures.Methods 40 patients with percutaneous pedicle fixation who were treated in our hospital from March 2014 to January 2016 were selected.They were assigned to the observation group and the control group according to a random number table,with 20 patients in each group.The control group was given the treatment of percutaneous pedicle fixation,and the observation group was given the combined treatment of closed manipulative reduction on the basis of percutaneous pedicle fixation.Clinical curative effect,imaging parameters,VAS scores and incidence rate of postoperative complications were compared between the two groups of patients.Results Incision length,volume of bleeding,volume of drainage,surgery time,length of stay and other indicators in the observation group were significantly better than those in the control group,and the differences were significant（P〈0.01）;the imaging parameters in the two groups of patients were not significantly different（P〉0.05）;VAS scores in the observation group for 1 d and3 d af ter the surgery were all lower than those in the control group,and the differences were statistically significant（t=3.8334,2.4901,P〈0.05）.After the surgery,1 case of deep venous thrombosis was detected in the control group,and was not detected in the observation group.In addition,other severe complications were not detected in the two groups.Conclusion Percutaneous pedicle fixation combined with closed manipulative reduction in the treatment of thoracolumbar spinal fractures is able to significantly improve the clinical curative effects,lower patients ′ VAS scores,and reduce surgical trauma,which is worthy of clinical promotion and application.