摘要:
Objective To explore the feasibility and effectiveness of transpedicular puncturing and poking reduction and pedicle screw fixation for the treatment of thoracic and lumbar vertebrae fractures .Methods Sixty-four patients with thoracic and lumbar vertebrae fracture from Feb .2012-mar.2015 were retrospectively analyzed , and were divided into observation group and control group ,with 32 cases in each group .The observation group was treated by puncturing and poking reduction outside of the pedicle ,bone grafting and pedicle screw fixation .The con-trol group was treated by the traditional distraction reduction by pedicle screw fixation ,transpedicular puncture and bone grafting in injured vertebral body .The operation time , intraoperative bleeding volume , postoperative drainage and length of stay were recorded .Anterior and posterior vertebral height and kyphosis Cobb angle were measured , and VAS score and Oswestry disability index score were recorded in both groups before and after operation .Results The preoperative VAS score was ( 6.782 ±1.821 ) points in the observation group , and was ( 6.827 ±1.762 ) points in the control group; preoperative anterior height percentage of injured vertebral body was ( 57.658 ± 23.645)% in the observation group ,and was (58.162 ±24.852 )% in the control group; preoperative posterior height percentage of injured vertebral body was (88.645 ±8.624) %in the observation group ,and was (87.927 ± 7.848)%in the control group,preoperative kyphosis Cobb angle was (28.665 ±4.824)°in the observation group, and was (29.134 ±5.508)°in the control group;operation time was (135.675 ±23.318) min in the observation group,and was (130.731 ±21.761) min in the control group; intraoperative bleeding volume was (456.214 ± 63.525) mL in the observation group ,and was (461.532 ±60.753) mL in the control group; postoperative drain-age was (43.847 ±16.358) mL in the observation group ,and was (42.971 ±15.523 ) mL in the control group;length of stay was (10.878 ±2.148) d in the observation group ,and was (11.323 ±2.512) d in the control group;postoperative VAS score was (0.184 ±0.263) points in the observation group ,and was (0.195 ±0.325) points in the control group and Oswestry disability index of final follow -up was(2.463 ±0.652 in the observation group ,and was (2.624 ±0.765) in the control group; all the indicators had no statistical difference between the observation group and the control group(P>0.05).The postoperative anterior height percentage of injured vertebral body (ob-servation group was 98.083 ±1.635,control group was 93.157 ±2.019),the postoperative posterior height percent-age of injured vertebral body (observation group was 98.504 ±2.572,control group was 96.248 ±4.824),and the postoperative kyphosis Cobb angle (observation group was 3.623 ±2.563°,control group was 7.626 ±3.613°)of fi-nal follow-up were found to have statistical differences between the observation group and the control group ( P0.05).观察组与对照组相比较,术后末次随访伤椎体前缘高度百分比(98.083±1.635)%vs.(93.157±2.019)%、后缘高度百分比[(98.504±2.572)%vs.(96.248±4.824)%]和后凸Cobb角[(3.623±2.563)°vs.(7.626±3.613)°],差异均有统计学意义(P<0.05).结论 经椎弓根外穿刺撬拨复位椎弓根螺钉固定治疗Denis B型、D型胸腰椎体压缩骨折、B型椎体爆裂骨折,可较好恢复椎体前、后缘高度,矫正后凸Cobb角.