光电导航下经伤椎置钉治疗单节段胸腰椎A型骨折的疗效

Effect of single segment type A thoracolumbar fractures treated by percutaneous pedicle screw with injured vertebral insertion undergoing photoelectric navigation

目的探讨光电导航下经伤椎置钉治疗单节段胸腰椎A型骨折的临床疗效。方法对46例单节段胸腰椎A型骨折患者行光电导航下经皮椎弓根螺钉(PPS)手术,其中24例经伤椎置钉(A组),22例跨伤椎置钉(B组)。记录疼痛VAS评分、手术时间、出血量、术中置钉一次性成功率,测量伤椎前高压缩比和Cobb角,观察术后神经、血管等相关并发症。结果 46例均获得随访,A组随访12~17个月,B组随访13~20个月。两组患者术后均无神经、血管等相关置钉并发症。手术时间和出血量:两组比较差异均无统计学意义(P>0.05)。末次随访VAS评分:两组与术前比较差异均有统计学意义(P<0.01);两组之间比较差异无统计学意义(P>0.05)。末次随访伤椎前高压缩比和Cobb角:两组与术前比较差异均有统计学意义(P<0.001);A组明显优于B组,差异有统计学意义(P<0.001)。置钉一次性成功率:A组为96.40%(134/139),B组为96.59%(85/88),两组比较差异无统计学意义(P>0.05)。结论光电导航下经伤椎PPS治疗单节段胸腰椎A型骨折,可纠正伤椎前高压缩比和Cobb角,获得满意的临床疗效。

Objective To investigate the effect of single segment type A thoracolumbar fractures treated by percuta-neous pedicle screw （ PPS） with injured vertebral insertion undergoing photoelectric navigation. Methods The 46 patients with single segment thoracolumbar fractures of type A had been operated by PPS surgery undergone photoelec-tric navigation, 24 cases with screws placed in injured vertebral （group A） ; while the other 22 cases with screws strode over injured vertebral （group B）. Both groups were evaluated by VAS, operation time, bleeding volume, re-lated complications（blood vessels and nerves） and one-time success rate of screw placement were recorded, the verte-bral anterior high compression ratio and Cobb angle were measured. Results T h ep a t ien tsw e re fo l low e d u p fo r l2- 17 months in group A and 13 ？20 months in group B,and no related complications （ blood vessels and nerves） oc-curred in the postoperative. The difference of operation time and bleeding volume had no statistical significance be-tween the two groups （ P 〉 0. 05 ）. The VAS had no significant difference between the two groups at the final follow-up （P 〉 0. 05） ; but statistical significance was found when compared with preoperative ones in each group （ P 〈 0. 01 ） . The vertebral anterior high compression ratio and Cobb angle in group A was significantly better than in group B at the final follow-up on the X-ray films （P 〈0. 001） ; and significant differences were also found when comparedwith preoperative ones in each groups （ P 〈 0. 001） . The one-time success rate of group A （ 96. 40% , 134/139 ） and B （96. 59% , 85/88） had no significant difference （P 〉0. 05） . Conclusions The treatment of single segment tho-racolumbar fractures of type A by PPS with injured vertebral insertion undergoing photoelectric navigation can correct the vertebral anterior high compression ratio and Cobb angle, which is satisfied with the clinical effect.