后路SSPI治疗A型胸腰段脊柱骨折的临床效果及影响因素研究

Study on the clinical effect and influence factors of posterior SSPI for the treatment of type A thoracolumbar spine fracture

目的探讨后路经椎弓根短节段固定术(SSPI)治疗A型胸腰段脊柱骨折的临床效果及影响因素。方法选择2014年1月至2015年10月接诊的90例A型胸腰段脊柱骨折的患者,通过随机数表法分为观察组和对照组,对照组使用传统的行内固定手术进行,观察组使用后路SSPI治疗。观察两组患者治疗前后影像学参数、椎管侵占率、目测类比评分的变化情况,治疗后椎管面积改善值、内固定失效率以及手术治疗及术后出血量情况。结果治疗后,观察组伤锥前缘高度比值(34.52±3.51)%低于对照组(39.56±6.03)%,椎管侵占率(24.73±5.08)%低于对照组(28.52±6.78)%,目测类比评分(5.07±0.12)也低于对照组(6.21±0.20)(P<0.05);观察组椎管面积改善值(43.19±4.24)%高于对照组(27.42±2.67)%,内固定失效率0.00%(0/45)低于对照组13.33%(6/45)(P<0.05);观察组手术时间和术中出血量[(68.18±10.12)min,(54.25±12.31)ml]均低于对照组[(74.05±14.19)min,(89.21±17.24)ml],差异具有统计学意义(P<0.05)。结论后路SSPI在A型胸腰段脊柱骨折患者中应用效果良好,给患者带来的创伤小,但手术中需注意的问题较多,临床上应进行严谨的操作。

Objective To investigate the clinical effect and influence factors of posterior SSPI for the treatment of type A thoracolumbar spine fracture. Methods 90 cases of type A thoracolumbar spine fracture patients from January 2014 to October 2015,were divided into observation group and control group randomly. The control group was treated with conventional internal fixation,and the observation group was treated with SSPI. The changes of imaging parameters,spinal canal encroachment rate and visual analogue score before and after treatment,the improvement value of postoperative vertebral canal area,the failure rate of internal fixation and intraoperative and postoperative bleeding volume were observed.Results After treatment,the ratio of the height of the anterior height of the observation group（ 34. 52 ± 3. 51） % was lower than that of the control group（ 39. 56 ± 6. 03） %,spinal canal occupation rate（ 24. 73 ± 5. 08） % was lower than that of the control group（ 28. 52 ± 6. 78） %,the visualanalogue score（ 5. 07 ± 0. 12） was lower than that of the control group（ 6. 21 ± 0. 20）（ P〈0. 05）. The improvement of spinal canal area in observation group（ 43. 19 ± 4. 24） was higher than that in control group（ 27. 42 ± 2. 67） %. The internal fixation failure rate of 0（ 0/45） was lower than that of the control group 13. 33%（ 6/45）（ P〈0. 05）. The observation group in the operation time and blood loss [（ 68. 18 ± 10. 12） min,（ 54. 25 ± 12. 3） ml]were lower than those of the control group [（ 74. 05 ± 14. 19） min,（ 89. 21 ± 17. 24） ml],there was statistically significant difference（ P〈0. 05）. Conclusion The clinical effect of posterior SSPI for the treatment of type A thoracolumbar spine fracture is good,the trauma is slight. While,the problems which should be payed more attention are more,which indicate the surgeon to perform rigorous operation.