【摘要】：目的探討經皮傷椎終板撬撥復位聯合短節(jié)段椎弓根螺釘內固定治療胸腰椎骨折的臨床療效。方法選擇胸腰椎骨折患者68例,隨機分為觀察組36例和對照組32例。觀察組采用經皮傷椎終板撬撥復位聯合短節(jié)段椎弓根螺釘內固定治療,對照組采用經皮短節(jié)段椎弓根螺釘內固定治療。記錄兩組術中出血量、手術時間;術前及術后1、3、7天采用酶分析法檢測血清肌酸激酶;術前、術后1周、術后12個月記錄疼痛視覺模擬評分(VAS)并行胸腰椎X線檢查,計算傷椎前緣高度比、傷椎終板高度比。結果觀察組與對照組術中出血量分別為(65.6±33.0)、(52.7±13.0)m L,手術時間分別為(107.9±10.2)、(83.9±9.5)min;兩組比較P均0.05。兩組術后1、3天血清肌酸激酶水平均高于同組術前(P均0.01),術后7天血清肌酸激酶水平與同組術前比較差異均無統(tǒng)計學意義(P均0.05)。兩組間手術前后各時間點血清肌酸激酶水平比較差異均無統(tǒng)計學意義(P均0.05)。兩組術后1周、術后12個月VAS均低于術前,且術后12個月降低更明顯(P0.05或0.01)。兩組術后1周、術后12個月傷椎前緣高度比、傷椎終板高度比均高于同組術前(P均0.01)。觀察組術后12個月傷椎前緣高度比、傷椎終板高度比均高于對照組,VAS低于對照組(P均0.05)。結論與經皮短節(jié)段椎弓根螺釘內固定比較,經皮傷椎終板撬撥復位聯合短節(jié)段內固定術治療胸腰椎骨折可更大程度地恢復脊柱生理曲度及傷椎完整性,減輕椎旁肌損傷及腰背部疼痛。
[Abstract]:Objective to investigate the clinical effect of percutaneous disc prying reduction combined with short segment pedicle screw fixation in the treatment of thoracolumbar fractures. Methods Sixty-eight patients with thoracolumbar fracture were randomly divided into observation group (n = 36) and control group (n = 32). The observation group was treated with percutaneous reduction of end plate and short segment pedicle screw fixation, while the control group was treated with percutaneous short segment pedicle screw fixation. Serum creatine kinase was detected by enzyme analysis before and 1 day after operation, and visual analogue score of pain (VAS) and thoracolumbar spine X-ray examination were recorded 1 week and 12 months after operation. The anterior height ratio of injured vertebrae and the ratio of end plate height of injured vertebra were calculated. Results the amount of intraoperative bleeding was (65.6 鹵33.0), () 52.7 鹵13.0) m L, in the observation group and (107.9 鹵10.2), (83.9 鹵9.5) min; in the control group (P < 0.05). The level of serum creatine kinase in the two groups was significantly higher than that in the same group on the 3rd day after operation (P 0.01), but there was no significant difference between the two groups on the 7th day after operation compared with the same group (P 0.05). There was no significant difference in serum creatine kinase levels between the two groups before and after operation (P 0.05). The VAS in both groups was lower than that before operation at 1 week and 12 months after operation, and the decrease was more significant at 12 months after operation (P0.05 or 0.01). At 1 week and 12 months after operation, the ratio of anterior height and end plate height of injured vertebrae in both groups was higher than that in the same group (P 0.01). At 12 months after operation, the ratio of anterior height and end plate height of injured vertebrae in the observation group was higher than that in the control group (P 0.05). Conclusion compared with percutaneous short segment pedicle screw internal fixation, the treatment of thoracolumbar fractures with percutaneous disc prying reduction combined with short segment internal fixation can recover the physiological curvature of spine and the integrity of injured vertebrae to a greater extent. Relieve paravertebral muscle injury and back pain.
【作者單位】： 臨沂市中心醫(yī)院;
【基金】：臨沂市科技發(fā)展計劃項目(201515034)
【分類號】：R687.3

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