局部麻醉下经皮椎弓根钉棒杠杆复位技术治疗胸腰椎骨折

Pereutaneons transpedicular screw and rob lever reduction technique under local anesthesia in the treatment of thoracolumbar fractures

目的 探讨局部麻醉下经皮椎弓根钉棒杠杆复位技术治疗胸腰椎骨折的疗效。方法将64例单节段胸腰椎骨折患者分别采用局部麻醉下经皮椎弓根钉棒杠杆复位技术治疗(观察组,32例)和全身麻醉下切开椎弓根钉棒撑开复位技术治疗(对照组,32例)。记录手术时间、术中出血量、术后引流量、术中麻醉效果、伤椎前缘高度百分比、矢状面后凸Cobb角、疼痛VAS评分。结果患者均获得随访,时间6~20个月。无神经损伤或其他并发症。观察组术中麻醉优良率为90.6%。手术时间、术中出血量、术后引流量观察组明显低于对照组(P<0.05);两组术前矢状面后凸Cobb角和椎体前缘高度百分比比较差异无统计学意义(P>0.05),术后1d、末次随访两项指标两组比较差异有统计学意义(P<0.05)。术后1、7dVAS评分观察组低于对照组(P<0.05),术后1、6个月VAS评分两组比较差异无统计学意义(P>0.05)。结论局部麻醉下经皮椎弓根钉棒杠杆复位技术是治疗胸腰椎骨折安全有效的手术方法,具有良好的骨折复位能力。

Objective To explore the therapeutic effect of percutaneous transpedicular screw and rob lever reduction under local anesthesia in the treatment of thoracolumbar fracture. Methods There were 64 patients with traumatic and single segment fracture of the thoracolumbar spine.The 32 patients in the observation group were treated with percutaneous pedicle screw and rob lever reduction under local anesthesia,while 32 patients in the control group were treated with open pedicle screw and rob distraction reduction under general anesthesia.The operative time, intraoperative blood loss volume, postoperative drainage volume,the effect of anesthesia during operation,the ratio of injured vertebral anterior margin height,the sagittal kyphposis Cobb angle and pain VAS were recorded. Results All patients were followed up from 6 months to 20 months.There were no aggravation nerve injuries and other severe complications. The excellent and good rate of anesthesia in the observation group was 90.6%.The operation time,intraoperative bleeding volume and postoperative drainage volume in the observation group were significantly lower than those of the control group ( P< 0.05). There were no significant difference in the sagittal kyphposis Cobb angle and vertebral anterior margin height between the two groups before operation ( P> 0.05),while there were significant differences at postoperative 1 d and last follow-up ( P< 0.05).The VAS of 1,7 d postoperation in the observation group were significantly lower than those in the control group ( P< 0.05), there were no significant differences in VAS between the two groups at 1,6 months after operation ( P> 0.05). Conclusions Percutaneous transpedicular screw and rob lever reduction in treating the thoracolumbar fractures under local anesthesia is a feasible and safe surgical procedure,which has good ability to restore the vertebra fracture.