闭合复位经皮椎弓根钉内固定及椎体植骨术治疗胸腰椎骨折的临床疗效研究

Study on clinical effect of closed reduction and percutaneous pedicle screw fixation and vertebral body bone grafting for the treatment of thoracolumbar fractures

目的研究闭合复位经皮椎弓根钉内固定及椎体植骨术治疗胸腰椎骨折患者的疗效。方法 60例胸腰椎骨折患者,随机分为研究组和对照组,每组30例。研究组采取闭合复位经皮椎弓根钉内固定及椎体植骨术治疗,对照组采用开放式椎弓根钉内固定治疗。比较两组患者术前、术后5 d、1个月、3个月视觉模拟评分法(VAS)评分;手术指标(术中出血量、手术时间、术中X线照射时间);手术前后Cobb角及伤椎前缘高度百分比。结果两组术后5 d、1个月、3个月VAS评分均低于本组术前,差异均具有统计学意义(P<0.05);研究组术后5 d、1个月、3个月VAS评分分别为(4.5±1.6)、(3.6±1.3)、(1.5±0.4)分,均明显低于对照组的(6.5±1.8)、(4.8±2.4)、(3.2±1.5)分,差异均具有统计学意义(P<0.05)。两组术后伤椎前缘高度百分比均高于本组术前, Cobb角均小于本组术前,差异具有统计学意义(P<0.05);研究组术后伤椎前缘高度百分比(92.15±3.61)%高于对照组的(87.84±5.12)%, Cobb角(7.2±2.1)°小于对照组的(8.3±1.5)°,差异具有统计学意义(P<0.05)。研究组患者术中出血量(67.5±10.2)ml少于对照组的(234.1±23.8)ml,手术时间(80.3±18.4)min和术中X线暴露时间(153.6±10.8)s长于对照组的(65.3±12.5)min、(53.8±12.3)s,差异均有统计学意义(P<0.05)。结论采用闭合复位经皮椎弓根钉内固定及椎体植骨术治疗胸腰椎骨折,出血量少,疼痛轻,骨折愈合好,是安全有效的方法。

Objective To study the efficacy of closed reduction and percutaneous pedicle screw fixation and vertebral body bone grafting for the treatment of thoracolumbar fractures. Methods A total of 60 thoracolumbar fractures patients were randomly divided into research group and control group, with 30 cases in each group. The research group was treated by closed reduction and percutaneous pedicle screw fixation and vertebral body bone grafting, and the control group was treated by open pedicle screw fixation. The visual analogue scale(VAS) score before operation, 5 d, 1 month and 3 months after surgery, surgical indicators(amounts of intraoperative hemorrhage, operation time, intraoperative X-ray irradiation time), Cobb angle and anterior height of injured vertebra before and after surgery were compared between the two groups. Results 5 d, 1 month and 3 months after surgery, VAS score of the two groups were lower than those before surgery of the same group, and the difference was statistically significant(P<0.05). 5 d, 1 month and 3 months after surgery, VAS score of the research group were(4.5±1.6),(3.6±1.3) and(1.5±0.4) points respectively, which were obviously lower than that of the control group(6.5±1.8),(4.8±2.4) and(3.2±1.5) points, and the difference was statistically significant(P<0.05). After surgery, the anterior height of injured vertebra of the two groups were higher than those before treatment of the same group, and Cobb angle were smaller than those before treatment of the same group, and the difference was statistically significant(P<0.05). After surgery, the anterior height of injured vertebra of the research group(92.15±3.61) was higher than those of the control group(87.84±5.12)%, and Cobb angle(7.2±2.1)° was smaller than that of the control group(8.3±1.5)°, and the difference was statistically significant(P<0.05). The amount of intraoperative hemorrhage(67.5±10.2) ml of the research group was less than that of the control group(234.1±23.8) ml, operation time(80.3±18.4) min and intraoperative X-ray irradiation time(153.6±10.8) s were longer than those of the control group(65.3±12.5) min and(53.8±12.3) s. The difference was statistically significant(P<0.05). Conclusion Closed reduction and percutaneous pedicle screw fixation and vertebral body bone grafting are safe and effective methods for the treatment of thoracolumbar fractures with less bleeding, lighter pain, and better fracture healing.