摘要: |
探讨胸腰椎骨折后路相邻伤椎单节段微创置钉治疗胸腰椎骨折适应症及疗效。方法 回顾性分析2013年3月~2016年11月21例因外伤致胸腰椎骨折但不伴有神经损害症状的患者临床资料21例。CT与MRI均提示无需行椎管减压,所有患者均采用经多裂肌间隙伤椎置钉单节段固定术式。统计术中出血量、手术时间、平均住院时间和术后并发症;术后症状改善用疼痛视觉模拟量表评分(visual analogue scale, VAS)评估;影像学评价通过患者手术前后和末次随访的矢状面后凸Cobb角、伤椎前缘高度丢失率来统计分析。结果 所有患者均顺利完成手术,术后无内固定失败和医源性神经损害并发症。21例患者2例失访,随访时间8~27(17.61±5.12)个月,平均手术时间84.28±20.60分钟,平均出血量140.51±56.94ml,平均住院时间7.28±1.69天。疼痛VAS评分从术前平均7.57±0.82分降至术后2.78±0.95分(P<0.05),伤椎前缘高度丢失率从术前平均30.53±7.88%降至术后5.52±1.53%(P<0.05),后凸Cobb角从术前平均18.47±4.18度降至术后平均5.84±1.69度(P<0.05)。末次随访VAS评分平均是1.26±0.44分与术后相比差异具有统计学意义(P<0.05)。末次随访伤椎丢失率和后凸Cobb角平均分别为7.26±1.74%与7.53±1.98度,与术后比较差异无统计学意义(P>0.05)。结论 后路经多裂肌间隙相邻伤椎置钉单节段固定治疗胸腰椎骨折具有创伤小、出血少、住院时间短等优点,严格把控适应症选择,此治疗方法临床疗效满意。 |
关键词: 胸椎 腰椎 骨折 微创 |
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Indications and effect of minimally invasive posterior approach single segmental pedicle screw implantation in treatment of thoracolumbar fractureLin Song, Wu Qiang, Zhou Xianwei, Liu Yufeng, Miao Jixian, Sun Yongqiang |
林松
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Department of Orthopedics, Luoyang Orthopedic Hospital of Henan Province,
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Abstract: |
Objective To explore the indications and clinical results of minimally invasive posterior approach single-segmental pedicle screw implantation in treatment of thoracolumbar fracture. Methods 21 cases from March 2013 to November 2016 of thoracolumbar fracture with minimally invasive posterior approach single-segmental pedicle screw implantation surgery were analyzed retrospectively. CT and MRI showed no need for spinal canal decompression. The evalutaion indicators included intraoperative blood loss, operative time, average hospitalization time, postoperative complications, visual analogue scale (VAS) score, Cobb’s angle and height loss rate of anterior edge of injured vertebrae are analysed. Results All patients have a smooth operation. No complications, such as internal fixation failure and nerve damage, were found after surgery. 19 patients were followed up and median follow up was 17.6±5.12 months (range 8 to 27 months). The mean operation time, intraoperative blood loss, and hospitalization time was 84.28±20.60 minutes, 140.51±56.94ml and 7.28±1.69 days, respectively. The average VAS score, the height loss rate of anterior edge of the injured vertebra and the Cobb’s angle of kyphosis were significantly improved after operation, and the difference was statistically significant compared with preoperative indicators (P<0.05). The average VAS score at the last follow-up was 1.3 points, the average loss rate of injured vertebrae was 7.26±1.74%, and the average Cobb’s angle of kyphosis was 7.53±1.98 degrees. Conclusions The clinical effect of minimally invasive approach single segmental pedicle screw implantation in treatment of thoracolumbar fracture is satisfactory if we can strictly follow the choice of indications. It has the advantages of small trauma, less bleeding and short hospitalization time. |
Key words: Thoracic vertebra Lumbar vertebra Fracture Minimally invasive surgery |