在野战综合手术救治方舱中行经皮椎弓根螺钉内固定术的实践

摘要

目的 探讨在战争或灾难救治现场利用新型野战综合手术救治方舱对无神经功能损伤的胸腰椎骨折行经皮椎弓根螺钉内固定术的近期临床疗效.方法 回顾性分析我院在综合手术救治方舱中救治的29例无神经损伤的胸腰椎骨折患者临床资料,其中男18例、女11例,平均(31.54±2.86)岁.29例患者均行经皮椎弓根螺钉内固定术.观察患者手术时间、术中失血量、术后下床锻炼时间及术后相关并发症,同时对比观察患者术前、术后的腰痛视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI)评分以及患者手术前后伤椎的椎体前缘高度及后凸Cobb's角.结果 29例患者均于野战综合手术救治方舱中顺利完成手术,术后一般状况良好,手术时间为(86.55±16.15)min,术中失血量为(42.35±6.55)mL,术后患者下地时间为(1.20±0.61)d,无并发症出现,术后胸腰部疼痛均得到明显改善,VAS评分、ODI评分及患者术后伤椎椎体前缘高度及脊柱后凸Cobb's角均得到明显改善,与术前比较差异具有统计学意义(P<0.05).结论 在野战综合手术救治方舱中行经皮椎弓根螺钉内固定术对无神经功能损伤的胸腰椎骨折早期治疗有效安全,可应用于战争或灾难现场紧急救治.%Objective To discuss the recent clinical efficacy of percataneous pedicle screw internal fixation for thoracolumbar fractures without neurological deficit in the new field comprehensive operation rescue shelter at the war or disaster treatment place.Methods Retrospectively analyzed the clinical data of 29 patients with thoracolumbar fractures who were rescued by our hospital.Those patients included 18 males and 11 females,with the average age of (31.54±2.86) years old.All these patients underwent percutaneous pedicle screw internal fixation in the new field comprehensive operation rescue shelter.Clinical and surgical evaluation including surgery time,blood loses,exercise time after operation and complications.Functional outcomes of pre-operation and post-operation were evaluated by visual analog scale (VAS) and Oswestry disability index (ODI).Cobb's angle and fracture vertebral body front height were compared before and after operation as well.Results All these patients were all successfully completed operation in the field comprehensive operation rescue shelter,and the general post-operation condition was well.The operation time was (86.55±16.15)min,the blood loss was (42.35±6.55)mL,the exercise time after operation was (1.20±0.61) days.There was no complications after operation, and pain of thoracolumbar after operation was obviously alleviated.There was statistical differences in terms of Cobb's angle,fracture vertebral body front height,VAS score and ODI score between pre-operation and post-operation (P<0.05).Conclusion The percataneous pedicle screw internal fixation in the new field comprehensive operation rescue shelter is a quite effective method for thoracolumbar fractures without neurological deficit, and this method is worthy of promoting at the scene when war or disaster urgency treatment.