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经皮与开放椎弓根螺钉短节段固定治疗A1~A3型胸腰椎骨折近期疗效比较
邢泽军,冀俊祥,郝帅,陈晨,冯皓宇,马迅
山西医学科学院,山西大医院脊柱外科,太原030032;山西省原平市第一人民医院骨科 034100
Comparison of short-time clinical efficacy of percutaneous and open pedicle screw fixation for type A1-A3 thoracolumbar fractures
Xing Zejun,Ji Junxiang,Hao Shuai,Chen Chen,Feng Haoyu,Ma Xun 

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摘要 

目的 探讨微创经皮与传统开放椎弓根螺钉短节段固定治疗A1~A3型胸腰椎压缩骨折的近期临床疗效.方法 采用回顾性病例对照研究分析2012年1月-2017年2月山西大医院收治的64例胸腰椎压缩骨折患者临床资料,其中男44例,女20例;年龄21 ~65岁[(45.4±11.1)岁].损伤节段:T11 1例,T12 29例,L1 27例,L27例.骨折AO分型:A1型39例,A2型2例,A3型23例.37例采用微创经皮椎弓根螺钉短节段固定撑开复位治疗(微创手术组),27例采用传统开放椎弓根螺钉短节段固定撑开复位治疗(开放手术组).记录两组手术时间、术中出血量、总住院时间、术后住院时间、手术前后视觉模拟评分(VAS)、伤椎椎体后凸角和矢状位节段性后凸Cobb角;观察并发症发生情况.结果 患者均获随访12 ~ 29个月,平均13.2个月.微创手术组和开放手术组手术时间分别为(106.4 _±37.3) min和(131.3±33.6)min(P >0.05),术中出血量分别为(71.2±34.9)ml和(409.3±267.5) ml(P <0.05),总住院时间分别为(11.7±7.2)d和(21.6±12.8)d,术后住院时间分别为(8.1±7.4)d和(16.6±10.6)d(P <0.05).微创手术组术前VAS为(6.5±1.1)分,术后即刻和末次随访分别为(2.3±0.7)分和(1.0±0.3)分;开放手术组分别为(6.9±1.0)分、(4.2±1.0)分和(0.9±0.4)分.两组术后即刻及末次随访与术前比较差异均有统计学意义(P<0.05),而两组间术前和末次随访比较差异均无统计学意义(P>0.05),而术后即刻两组间差异有统计学意义(P<0.05).微创手术组伤椎椎体后凸角术前为(19.3±3.8)°,术后即刻和末次随访分别为(3.4±1.7)°和(4.6±1.9)°;开放手术组分别为(19.6±6.8)°、(1.6±0.8)°和(2.4±1.1)°.两组术后即刻和末次随访与术前比较差异均有统计学意义(P<0.05),而两组间比较差异均无统计学意义(P>0.05).微创手术组矢状位节段性后凸Cobb角术前为(16.1±9.1)°,术后即刻和末次随访分别为(3.0±1.8)°和(5.9±1.8)°;开放手术组分别为(15.2±12.0)°、(3.1±1.4)°和(5.6±2.1)°.两组术后即刻和末次随访与术前比较差异均有统计学意义(P<0.05),而两组间比较均差异无统计学意义(P>0.05).术后未出现因椎弓根螺钉置钉导致脊髓神经损伤患者.开放手术组1例伤口感染,经换药后愈合;微创手术组无伤口感染患者.结论 经皮与开放椎弓根螺钉短节段固定治疗胸腰椎Al ~ A3型骨折均可获得满意的近期临床疗效,而前者仅术中出血量、术后即刻缓解疼痛及缩短住院时间方面优于开放椎弓根螺钉短节段固定.

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邢泽军
冀俊祥
郝帅
陈晨
冯皓宇
马迅
关键词 脊柱骨折骨折固定术椎弓根螺钉    
Abstract

Objective To investigate the clinical efficacy of short segment fixation with percutaneous pedicle screws or traditional open surgery for the type A1-A3 thoracolumbar compression fracture.Methods A retrospective case control study was conducted on the clinical data of 64 patients with thoracolumbar compression fracture admitted to Shanxi Dayi Hospital between January 2012 and February 2017.There were 44 males and 20 females,aged 21-65 years [(45.4 ± 11.1) years].There was one patient with injured segment at T11,29 at T12,27 at L1 and seven at L2.According to AO typing,there were 39 patients classified as Type A1,two as Type A2 and 23 as Type A3.The patients were divided into minimally invasive surgery group (n =37) and open surgery group (n =27).Minimally invasive surgery group was treated with minimally invasive percutaneous pedicle screw fixation and open reduction.The open surgery group was treated with traditional open pedicle screw short segment fixation and open reduction.The operation time,intraoperative blood loss,total hospitalization time,postoperative hospitalization time,visual analogue scale (VAS) before and after operation,local kyphosis of the fractured vertebra,segmental kyphosis and complications in two groups were recorded.Results All patients were followed up for 12-29 months,with an average of 13.2 months.Between the minimally invasive surgery group and open surgery group,no significant difference was found in the operation time [(106.4± 37.3) minutes vs.(131.3 ± 33.6) minutes] (P > 0.05),and significant differences were found in intraoperative blood loss [(71.2 ± 34.9) ml vs.(409.3 ± 267.5) ml],total hospitalization time [(11.7 ± 7.2) days vs.(21.6 ± 12.8) days] and postoperative hospitalization time [(8.1 ± 7.4) days vs.(16.6 ± 10.6) days] (P < 0.05).In the minimally invasive surgery group,VAS was (6.5 ±1.1) points preoperatively and was (2.3 ± 0.7) points and (1.0 ± 0.3) points immediately after operation and at final follow-up.In the open surgery group,VAS was (6.9 ± 1.0)points preoperatively and was (4.2 ± 1.0) points and (0.9 ± 0.4) points immediately after operation and at final follow-up (P <0.05).Compared with the preoperative VAS,those immediately after operation and at final follow-up were significantly decreased within the two groups (P < 0.05).There were no significant differences in the preoperative VAS and VAS at final follow-up between the two groups (P > 0.05),but significant difference was found in VAS immediately after operation between the two groups (P < 0.05).In the minimally invasive surgery group,the local kyphosis of the fractured vertebra was (19.3 ± 3.8) °preoperatively,(3.4 ± 1.7) ° immediately after operation,and (4.6 ± 1.9) ° at final follow-up.In the open surgery group,the local kyphosis of the fractured vertebra was (19.6 ± 6.8) ° before operation,(1.6 ± 0.8) ° immediately after operation,and (2.4 ± 1.1) ° at final follow-up.The kyphosis of fractured vertebra immediately after operation and at final follow-up were significantly decreased within the two groups compared with the preoperative kyphosis(P <0.05),but no significant differences were found between the two groups (P > 0.05).In the minimally invasive surgery group,the segmental kyphosis Cobb angle was (16.1 ± 9.1) ° before operation,(3.0-± 1.8) ° immediately after operation,and (5.9 ±1.8) ° at final follow-up.In the open surgery group,the segmental kyphosis Cobb angle was (15.2±12.0) ° before operation,(3.1 ± 1.4) ° immediately after operation,and (5.6 ± 2.1) ° at final follow-up.The segmental kyphosis Cobb angle immediately after operation and at final follow-up were significantly decreased within the two groups compared with the preoperative Cobb angle (P < 0.05),but no significant differences were found between the two groups (P > 0.05).No spinal cord injuries because of pedicle screws were observed after operation in either group.In the open surgery group,there was one patient with wound infection who recovered after dressing change,and no infection case was found in the minimally invasive surgery group.Conclusion For type A1-A3 thoracolumbar compression fractures,both the minimally invasive posterior pedicle screw fixation and the traditional open pedicle screw fixation can achieve satisfactory near-term results,and the former is better in intraoperative blood loss,immediate relief of pain after operation and shorter hospital stay than the latter.

Key wordsSpinal fractures    Fracture fixation,internal    Pedicle screws   
     出版日期: 2019-08-30
通讯作者: 马迅,Email:maxun2532@sina.com,电话:13603532532   
引用本文:   
邢泽军,冀俊祥,郝帅,陈晨,冯皓宇,马迅. 经皮与开放椎弓根螺钉短节段固定治疗A1~A3型胸腰椎骨折近期疗效比较[J]. 中华创伤杂志, 2019, 35(1): 14-21. Xing Zejun,Ji Junxiang,Hao Shuai,Chen Chen,Feng Haoyu,Ma Xun. Comparison of short-time clinical efficacy of percutaneous and open pedicle screw fixation for type A1-A3 thoracolumbar fractures. CHINESE JOURNAL OF TRAUMA, 2019, 35(1): 14-21.
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