经皮椎弓根螺钉内固定治疗胸腰椎单椎体A3型骨折

Clinical Effect of Percutaneous Pedicle Screw Internal Fixation in Treatment of Single-vertebral Type A3 Thoracolumbar Fractures

【目的】探讨经皮椎弓根螺钉内固定治疗胸腰椎单椎体A3型骨折的临床疗效。【方法】选取2016年8月至2018年8月在南方医科大学附属郴州市第一人民医院脊柱外科诊治的40例胸腰椎单椎体A3型骨折患者,按照患者意愿分为观察组和对照组,每组20例。观察组采用经皮椎弓根螺钉内固定手术,对照组采用后路开放手术,比较两组围术期指标及术前、术后视觉模拟疼痛评分(VAS)和Cobb's角、椎体前缘高度百分比。【结果】观察组患者术中出血量、手术时间、切口长度、术后渗出量和住院天数均少于对照组,其差异均有统计学意义(均P>0.05)。两组患者术前VAS评分比较差异无统计学意义(均P>0.05);观察组患者术后1周、术后1个月、术后3个月及术后6个月的VAS评分均显著低于对照组,其差异均有统计学意义(均P<0.05)。两组患者入院时、术后1个月和术后1年Cobb's角、椎体前缘高度百分比比较差异均无统计学意义(均P>0.05)。【结论】采用经皮椎弓根螺钉内固定治疗胸腰椎单椎体A3型骨折,切口小、住院时间短、出血量少、疼痛轻,疗效显著,值得临床推广应用。

【Objective】To explore the clinical effect of the percutaneous pedicle screw internal fixation in the treatment of single-vertebral type A3 thoracolumbar fractures.【Methods】From August 2016 to August 2018,a total of 40 patients with single-vertebral type A3 thoracolumbar fracture admitted in the First People's Hospital of Chenzhou were analyzed.They were divided into the observation group and the control group,with 20 cases in each group.Patients in the observation group received percutaneous pedicle screw internal fixation,while patients in the control group received posterior open surgery.The perioperative indexes,preoperative and postoperative VAS scores,Cobb's angle,and the percentage of the anterior edge of the vertebral body were compared between the two groups.【Results】Blood loss was(101.0±11.2)mL in the observation group and(360±29.3)mL in the control group(P<0.01).Operation time was(96.0±9.8)min in the observation group and(133.6±9.5)min in the control group(P<0.01).Incision length was(7.2±0.5)cm in the observation group and(14.3±1.3)cm in the control group(P<0.01).Postoperative effusion was(15.0±3.28)mL in the observation group and(144.5±21.6)mL in the control group(P<0.01).Postoperative hospital stay was(9.0±0.86)d in the observation group A and(16.3±1.0)d in the control group.The amount of blood loss,operation time,incision length,postoperative exudation,and hospital stay in the observation group were less than those in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in the preoperative VAS scores between the two groups(all P>0.05).VAS scores at 1 week,1 month,3 months,and 6 months after surgery in the observation group had significant lower than those in the control group;the difference was statistically significant(P<0.05).There was no significant difference between the two groups in the preoperative Cobb angle and anterior height ratio of the injured vertebrae(P>0.05).There were no significant differences in the Cobb angle and the anterior height of vertebral body at admitting to hospital,postoperative one month and one year after operation(P>0.05).【Conclusion】Minimally invasive percutaneous pedicle internal screw fixation without decompression pressure in the treatment of single-vertebral type A3 thoracolumbar fractures has better clinical curative effect than open surgery.It also provides less bleeding,shorter hospitalization time,a small incision,less postoperative pain and quicker recovery.