微创经皮椎弓根螺钉内固定联合PVP术治疗胸腰椎骨折的临床研究

摘要

目的 观察评价微创经皮椎弓根螺钉(PPS)内固定联合椎体成形术(PVP)治疗胸腰椎骨折(TF)的临床效果.方法 选择2011年2月至2015年2月期间中山市陈星海医院骨科收治无神经损伤的胸腰椎骨折患者46例,按照数字法分为两组,对照组23例给予传统切开复位椎弓根螺钉内固定治疗;观察组23例则行微创经皮椎弓根螺钉内固定联合PVP术治疗,并比较两组的临床效果.结果 两组手术切口、手术时间、术中出血量及住院时间比较,差异均有统计学意义(均P＜ 0.05);观察组术前VAS评分(8.43±1.51)分,术后(1.48±0.41)分,对照组术前VAS评分(8.39±1.55)分,术后(2.39±1.01)分,两组术后VAS评分比较差异有统计学意义(P＜0.05);两组术后3个月、12个月IVHR、VEHR均显著高于同组术前(均P＜ 0.05);观察组术后12个月IVHR、VEHR均明显的高于对照组(均P＜0.05),两组术后3个月、12个月Cobb's角、伤椎后凸角均显著低于同组术前(P＜0.05);观察组术后12个月Cobb's角明显低于对照组(P＜0.05),而两组术后12个月伤椎后凸角差异无统计学意义(P＞0.05).结论 微创PPS内固定联合PVP术治疗TF疗效确切,可以显著降低患者的损伤程度,减少并发症发生率,值得临床骨科大力推广应用.%Objective To evaluate the clinical effect of minimally invasive percutaneous internal fixation with pedicle screw combiningvertebroplasty (PVP) in the treatment of thoracolumbar fractures (TF).Methods From February 2011 to February 2015,46 cases of thoracolumbar fractures without neurological injury were admitted into our department,and were divided into a control group and an observation according.The control group were given conventional open reduction and fixation with pedicle screw;and the observation group were treated with minimally invasive percutaneous fixation with pedicle screw and PVP.The clinical effects of the two groups were compared.Results There were statistical differences in surgical incision,operation time,intraoperative bleeding volume,and hospital stay between the two groups (all P ＜0.05).The preoperative and postoperative VAS scores were (8.43 ± 1.51) and (1.48 ± 0.41) in the observation group,and were (8.39 ± 1.55) and (2.39 ± 1.01) in the control group;and there was statistical difference between the two groups (P ＜0.05).The levels of IVHR and VEHR were significantly higher 3 and 12 months after than before operation in the two groups (P ＜0.05).The Cobb's angle and kyphosis angle were significantly lower 3 and 12 months after than before operation in the two groups (P ＜0.05).The Cobb's angle was significantly lower in the observation group than in the control group (P ＜0.05),but with no statistical difference between the two groups 12 months after operation (P＞ 0.05).Conclusion Minimally invasive percutaneous fixation with pedicle screw combining PVP for thoracolumbar fractures (TF) has a significant effect,can effectively reduce the patients' injury degree and reduce the incidence of complications,so it is worth for clinical orthopaedic promotion and application.