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微创经皮椎弓根螺钉治疗胸腰椎骨折在急诊科的应用研究 被引量:3

Application of minimally invasive percutaneous pedicle screw in the treatment of thoracolumbar fractures in emergency department
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摘要 目的:探讨急诊科开展微创经皮椎弓根螺钉技术早期治疗胸腰椎骨折的安全性和可靠性。方法:2014-01—2016-12期间对我院急诊科的26例胸腰椎骨折实施早期微创经皮椎弓根螺钉固定、复位、减压术(微创手术组),其中男19例,女7例;平均年龄42.5岁;T12 6例,L1 9例,L2 7例,L3 4例;AO分型A3 12例,C1 10例,C2 4例;ASIA脊髓神经功能障碍分级A级9例,B级12例,C级3例,D级2例。记录入院到手术等待时间,手术切口长度,手术时间,术中出血量,术后伤口引流量,术后伤口疼痛评分,住院时间,术后伤椎Cobb角、椎体高度、椎管容积、神经功能变化,与28例同期住院行传统开放手术患者(开放手术组)进行比较。结果:微创手术组患者入院到脊柱手术等待的时间为(3.6±2.1)d,手术切口肌肉剥离长度为(6.9±1.2)cm,手术时间为(2.7±0.6)h,术中出血量为(220.0±152.6)ml,术后伤口引流量为(104.5±47.6)ml,术后伤口疼痛评分为2.3±1.3,住院时间为(7.8±5.6)d,开放手术组分别为(8.4±2.4)d、(18.6±2.4)cm、(2.2±0.7)h、(668.0±176.2)ml、(252.0±74.7)ml、(5.6±1.7)、(16.2±6.9)d,差异有统计学意义(P<0.01)。两组患者术后均无并发症发生,术后伤椎Cobb角、椎体高度、椎管容积变化,随访1年神经功能恢复差异无统计学意义。结论:急诊微创经皮椎弓根螺钉早期治疗胸腰椎骨折是安全和可靠的,有利于患者康复。 Objective:To investigate the safety and reliability of minimally invasive percutaneous pedicle screw technique for early treatment of thoracolumbar fractures in emergency department.Method:From January 2014 to December 2016,26 patients with thoracolumbar fractures admitted to the emergency department were treated with early minimally invasive percutaneous pedicle screw fixation,reduction and decompression(minimally invasive operation group).The patients were from 30 years to 58 years with an average of 42.5 years.Compared with the other28 cases undergoing traditional open surgery(open surgery group)who were hospitalized during the same period,the waiting time from admission to operation,the length of incision,the operative time,the blood loss during surgery,the drainage,the postoperative wound pain score,the hospitalization time,the postoperative Cobb angle,the vertebral body height,the spinal canal volume and the nerve function changes were evaluated separately.Result:Compared with open surgery group,the waiting time from admission to operation was(3.6±2.1)day vs(8.4±2.4)day,the length of incision was(6.9±1.2)cm vs(18.6±2.4)cm,the operative time was(2.7±0.6)h vs(2.2±0.7)h,the blood loss during surgery was(220.0±152.6)ml vs(668.0±176.2)ml,the drainage was(104.5±47.6)ml vs(252.0±74.7)ml,the postoperative wound pain score was2.3±1.3 vs 5.6±1.7,the hospitalization time was(7.8±5.6)day vs(16.2±6.9)day.All showed significant differences between the two groups(P〈0.01).There were no postoperative complications in both groups.There was no significant difference in Cobb angle,height of vertebral body and volume of spinal canal.There was no significant difference in the recovery of nerve function after 1 year follow up.Conclusion:Emergency minimally invasive percutaneous pedicle screw early treatment of thoracolumbar fractures is safe and reliable,which is beneficial to the rehabilitation of patients.
作者 向强 田君 王伟 田铸 任鸿 朱浩然 刘明华 XIANG Qiang;TIAN Jun;WANG Wei;TIAN Zhu;REN Hong;ZHU Haoran;LIU Minghua(The Center of Emergency and Trauma, Southwest Hospital,the Third Military Medical University, Chongqing, 400038, Chin)
出处 《临床急诊杂志》 CAS 2018年第5期279-282,共4页 Journal of Clinical Emergency
基金 陆军军医大学西南医院重大领域技术创新计划项目(No:SWH2016ZDCX3005)
关键词 急诊 胸腰椎骨折 微创 手术 emergency thoracic and lumbar fracture minimal invasive surgical operation
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