微创通道下经皮椎弓根钉内固定结合减压术治疗伴有神经功能损伤的A3型胸腰椎骨折的临床疗效

Clinical Effect of Percutaneous Pedicle Screw Internal Fixation Combined with Decompression in the Treatment of A3 Thoracolumbar Fractures with Nerve Function Damage under Minimally Invasive Channel

目的探索微创通道下经皮椎弓根钉内固定结合减压术(简称为微创通道下减压术)治疗A3型胸腰椎骨折合并神经功能损伤患者的临床疗效。方法选择114例伴有神经功能损伤的A3型胸腰椎骨折患者为试验对象,根据等距抽样法分2组,观察组57例进行微创通道下减压术干预,对照组57例进行传统后路开放椎弓根内固定术治疗,并比较两组围术期相关指标以及治疗后各时间段日本骨科协会评估治疗分数(JOA)评分、Cobb角、伤椎前缘高度比,同时还需统计治疗后12个月的神经功能恢复分级情况。结果观察组术中出血量少于对照组,手术时间、切口长度短于对照组,术后24h VAS评分低于对照组(P<0.05)。经重复测量方差分析,两组伤椎前缘高度比、Cobb角、JOA评分的主体内效应、主体间效应比较均有显著差异(P<0.05),且事后LSD-t成对比较,观察组治疗后各时间段伤椎前缘高度比、Cobb角、JOA评分更优于对照组(P<0.05),同时观察组治疗后6个月的E级率19.30%高于对照组E级率3.51%(P<0.05)。结论对A3型胸腰椎骨折合并神经功能损伤患者实施微创通道下减压术治疗,可改善术后腰椎稳定性,恢复受损神经功能。

Objective To explore the clinical efficacy of minimally invasive percutaneous pedicle screw fixation combined with decompression in the treatment of type A3 thoracolumbar fractures complicated with neurological injury.Methods 114 patients with type A3 thoracolumbar fractures with neurological injury were selected as the subjects.According to the equidistant sampling method,they were divided into two groups.57patients in the observation group were treated with minimally invasive decompression under the channel,and 57 patients in the control group were treated with traditional posterior open pedicle internal fixation.The perioperative related indexes and the JOA score,Cobb angle and the height ratio of the anterior edge of the injured vertebra of the two groups were compared,At the same time,the classification of neurological function recovery 12 months after treatment needs to be counted.Results The amount of intraoperative bleeding in the observation group was less than that in the control group,the operation time and incision length were shorter than those in the control group,and the VAS score 24hours after operation was lower than that in the control group(P<0.05).After repeated measurement analysis of variance,there were significant differences between the two groups in the intra subject and inter subject effects of the anterior edge height ratio,Cobb angle and JOA score(P<0.05).After LSD-t pairwise comparison,the anterior edge height ratio,Cobb angle and JOA score of the observation group were better than those of the control group(P<0.05).At the same time,the E-grade rate of the observation group 6 months after treatment was 19.30%higher than that of the control group by 3.51%(P<0.05).Conclusion Minimally invasive decompression of type A3 thoracolumbar fracture combined with nerve function injury can improve postoperative lumbar stability and restore damaged nerve function.