经皮椎弓根螺钉内固定治疗胸腰段骨折的围手术期临床研究

摘要

Objective To evaluate the clinical result of the percutaneous pedicle screw fixation in the treatment of thoraco -lumbar fractures by comparing with the open reduction and pedicle screw fixation .Methods A retrospective study of a con-secutive 43 patients with Type A1 and A2 thoracolumbar fractures according to the AO classification , which had been fixed by pedicle screws through the posterior approach from January 2011 to January 2013.The patients were divided into 2 groups ran-domly .Twenty-two patients were treated with the posterior open reduction and pedicle screw fixation and 21 patients performed the closed reduction and percutaneous pedicle screw fixation .The data of the incision size , blood loss, duration of operation, hospital stay and visual analogue scale ( VAS) scores in 2 groups were compared .The fractured vertebral body angle and ante-rior vertebral body height of the 2 groups respectively were evaluated .Results All patients were followed up for 3-12 months (average 8.5 months) .All the perioperative data was significantly less in the percutaneous pedicle screw fixation group (P<0.05) except that the duration of operation was equal in 2 groups.There was no significant difference in all the radiological assessment including the Cobb ’s angle of fractured vertebral and anterior vertebral body height (P>0.05).Conclusion The Type A1 and A2 thoracolumbar fracture patients treated with closed reduction and percutaneous pedicle screw fixation has less surrounding tissue damage and can recover more quickly .The ability of correcting deformity by using closed reduction and per-cutaneous pedicle screw fixation is equal to the open operation in the Type A 1 and A2 thoracolumbar fracture .%目的：评价闭合复位经皮椎弓根螺钉固定治疗胸腰段骨折的临床应用价值。方法研究对象为本院2011年1月～2013年1月收治的连续43例AO分类为A1、A2型胸腰段骨折患者，分别行腰椎后路开放复位椎弓根螺钉固定手术和腰椎闭合复位经皮椎弓根螺钉固定手术。2组患者年龄、骨折分布无差异。回顾性分析比较2组患者手术时间、出血量、切口长度、住院天数、疼痛视觉模拟量表（ visual analogue scale ， VAS）评分。术前、术后摄腰椎正侧位X线片，比较2组患者伤椎高度、伤椎Cobb角。结果2组患者手术时间差异无统计学意义（P＞0．05）；经皮手术组患者术中出血量、术后引流量、平均住院天数、切口长度明显小于开放手术组（ P＜0．05），术后VAS评分明显少于开放手术组（P＜0．05）。2组手术在矫正伤椎高度及伤椎Cobb角能力方面相比差异无统计学意义（P＞0．05）。结论腰椎闭合复位经皮椎弓根螺钉内固定手术治疗AO分类为A1、A2型胸腰段骨折具有手术创伤小、术后恢复快的优点，其矫形能力与开放复位椎弓根螺钉内固定术相当。