经皮微创椎弓根钉内固定术治疗创伤性胸腰椎压缩骨折的临床效果分析

摘要

Objective To research the clinical effect of minimally invasive percutaneous pedicle screw fixation for traumatic thoracolumbar vertebral compression fractures.Methods A total of 15 traumatic thoracolumbar vertebral compression fractures patients,injured vertebral body located in T12-L3 and definited A3 type fracture,were included.There were no symptoms of spinal cord injury.Minimally invasive percutaneous pedicle screw fixation was used.The operation time,amount of bleeding,postoperative drainage,and hospitalization time were observed.All patients were followed up for 12 months,observed and recorded the changes of anterior vertebral height ratio,sagittal kyphotic cobb angle,intervertebral height and VAS score before surgery,immediately after surgery,postoperative 2 month,6 months and 12 months.Results The average operation time was (85 ± 8.4) min,the amount of hemorrhage was (80.8 ± 17.8) mL,postoperative drainage volume was (3.2 ± 0.8) mL,hospitalization time was (6.8 ± 0.8) d.Wound infection,iatrogenic nerve root injury,pedicle screw extrusion,fracture and other complications were not found during hospitalization.There were significant differences in the VAS score at different time points after operation (P ＜ 0.01).The percentage of anterior vertebral height,cobs angle and intervertebral height were better after operation than before surgery.Pedicle screw extrusion,fracture and other complications were not found in all patients.Conclusion The application of minimally invasive percutaneous pedicle screw fixation for the treatment of traumatic thoracolumbar vertebral compression fracture has a few advantage of reduction and fixation surgery,smaller wound,less bleeding,less postoperative complications,less pain and faster recovery speed.%目的:研究经皮微创椎弓根钉内固定治疗创伤性胸腰椎压缩骨折的临床效果.方法:15例创伤性胸腰椎压缩骨折患者,受伤椎体位于T12-L3,均属于A3型骨折,均无脊髓神经损伤症状,采用经皮微创椎弓根钉内固定手术治疗,观察和记录手术时间、术中出血量、术后引流量、住院时间.15例患者均进行12个月随访,观察和记录手术前、手术后即刻、术后2个月、6个月、12个月在伤椎前缘高度的百分比、矢状面后凸Cobb角、椎间隙高度、VAS评分等指标的变化.结果:本组患者平均手术时间为(85.0±8.4) min,术中出血量为(80.8±17.8) mL,术后引流量为(3.2±0.8)mL,住院时间为(6.8±0.8)d,术后5～7 d均可戴腰围支具下床活动.术后住院期间均未出现严重伤口感染、医源性神经根损伤、椎弓根钉脱出、断裂等术后并发症.15例患者的术后各时间点VAS评分与术前相比差异均有显著统计学意义(P＜0.01).15例患者术后各时间点的伤椎椎体前缘高度百分比、Cobs角与椎间隙高度与术前相比,均有显著恢复(P＜0.01).术后随访过程中全部患者均未出现椎弓根钉脱出、断裂等术后并发症.结论:应用经皮微创椎弓根钉内固定治疗创伤性胸腰椎压缩性骨折的复位及固定效果良好,且具有手术创口小、出血量少、患者术后并发症少、疼痛轻、恢复速度快等优点.