经皮椎弓根螺钉内固定术治疗胸腰椎骨折的临床疗效

Clinical Efficacy of Percutaneous Pedicle Screw Fixation for Thoracolumbar Fractures

目的探讨采用经皮椎弓根螺钉内固定术治疗无神经损伤的单节段胸腰椎骨折患者的临床疗效。方法选取40例胸腰椎骨折患者为研究对象,采用经皮椎弓根螺钉内固定术治疗,并对患者手术时间、切口平均长度、术中出血量、住院时间进行记录。对所有患者进行随访,观察和记录手术前、手术后1周、术后6个月及末次随访的影像学指标[包括术后Cobb角及伤椎前缘高度百分比(RAVH)]、日本骨科协会(Japanese Orthopaedic Association,JOA)腰疼评分、Oswestry功能障碍指数(oswestry disability index,ODI)及视觉模拟评分法(visual analogue scale,VAS)评分,评价临床结果的改善程度。结果所有手术均顺利完成,患者平均手术时间(76.2±7.2)min,术中平均出血量(68.5±3.8)mL,切口平均长度(11.8±0.9)cm,平均住院时间(10.1±1.2)d。术后及随访期间均未出现感染、内固定物松动及断裂等并发症。患者术后一周Cobb角较术前显著改善,RAVH较术前显著增加(P<0.05);术后6个月较术后一周及末次随访较术后6个月比较,患者Cobb角略有增加,RAVH略有丢失,但差异无统计学意义(P>0.05)。患者术前、术后一周、术后一月及末次随访患者JOA评分显著增加,而VAS和ODI评分随时间推移而显著减少,差异在不同时间点具有统计学意义(P<0.05)。结论经皮椎弓根螺钉内固定术在治疗胸腰椎骨折时,可以有效恢复伤椎椎体高度,纠正矢状面后凸Cobb角,恢复脊柱生理曲度,具有显著的临床疗效。

Objective To explore the clinical efficacy of percutaneous pedicle screw fixation for the treatment of single segment thoraco⁃lumbar fractures without nerve injury in patients.Method Forty patients with thoracolumbar fractures were selected as the research sub⁃jects and treated with percutaneous pedicle screw fixation.The surgical time,average incision length,intraoperative bleeding,and hospi⁃talization time of the patients were recorded.Follow up all patients,observe and record imaging indicators[including postoperative Cobb angle and percentage of anterior edge height(RAVH)],Japanese Orthopedic Association(JOA)low back pain score,Oswestry Disability Index(ODI),and Visual Analog Scale(VAS)scores before surgery,1 week after surgery,6 months after surgery,and the last follow-up,to evaluate the degree of improvement in clinical outcomes.Result All surgeries were successfully completed,with an average surgical time of(76.2±7.2)minutes,an average intraoperative bleeding volume of(68.5±3.8)mL,an average incision length of(11.8±0.9)cm,and an average hospital stay of(10.1±1.2)days.There were no complications such as infection,loosening or rupture of internal fixation during the postoperative and follow-up periods.The Cobb angle of the patient improved significantly one week after surgery compared to before,and the RAVH increased significantly(P<0.05);Compared to the first week after surgery and the last follow-up,the Cobb angle of pa⁃tients increased slightly and RAVH was slightly lost 6 months after surgery,but the difference was not statistically significant(P>0.05).The JOA score of patients significantly increased before surgery,one week after surgery,one month after surgery,and the last follow-up,while VAS and ODI scores significantly decreased over time,with statistical significance(P<0.05)at different time points.Conclusion Percutaneous minimally invasive pedicle screw fixation can effectively restore the height of the injured vertebral body,correct the Cobb angle of sagittal kyphosis,and restore the physiological curvature of the spine in the treatment of thoracolumbar fractures.It has signifi⁃cant clinical efficacy.