过伸牵引弹性按压联合经皮椎弓根螺钉内固定术治疗胸腰椎骨折临床观察
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摘要
目的探讨过伸牵引弹性按压联合经皮椎弓根螺钉内固定术治疗胸腰椎骨折的临床效果。方法选择单节段胸腰椎骨折患者97例,按治疗方法不同分为观察组48例、对照组49例。对照组采用经皮椎弓根螺钉内固定术治疗,观察组采用过伸牵引弹性按压联合经皮椎弓根螺钉内固定术治疗。比较两组手术时间、术中出血量、下地活动时间、住院时间,术前、术后1天、术后6个月疼痛视觉模拟评分(VAS)、伤椎矢状位后凸Cobb’s角和椎体前缘高度百分比,以及术前和术后6个月Oswestry功能障碍指数(ODI)。结果两组手术时间、术中出血量、下地活动时间和住院时间比较差异均无统计学意义(P均> 0. 05)。两组术后1天和术后6个月VAS、伤椎矢状位后凸Cobb’s角较术前均明显降低,伤椎椎体前缘高度百分比较术前均明显升高,但观察组术后变化更明显(P均<0. 05);两组术后1天与术后6个月上述指标变化不明显(P均> 0. 05)。两组术后6个月ODI较术前均明显降低,但观察组术后6个月变化更明显(P均<0. 05)。结论过伸牵引弹性按压联合经皮椎弓根螺钉内固定术治疗胸腰椎骨折临床效果较好,不仅能促使骨折复位,还能提升患者生活能力。
Objective To investigate the clinical effect of hyperextension traction elastic pressure combined with percutaneous pedicle screw fixation in treatment of thoracolumbar fracture. Methods According to different treatment methods,97 patients with single segment thoracolumbar fracture were divided into the observation group of 48 cases and the control group of 49 cases. The patients in the control group were treated with percutaneous pedicle screw fixation,while patients in the observation group were treated with hyperextension traction elastic pressure combined with percutaneous pedicle screw fixation. The operation time,intraoperative bleeding volume,ambulation time,hospitalization time,visual analogue scale of pain( VAS) before operation,1 day after operation and 6 months after operation,Cobb's angle of sagittal kyphosis of injured vertebrae and vertebral height,Oswestry dysfunction index( ODI) before and 6 months after operation was compared between the two groups. Results There were no significant differences in the operation time,intraoperative bleeding volume,ambulation time or hospitalization time between the two groups( all P > 0. 05). The VAS and Cobb's angle of sagittal kyphosis of the injured vertebrae decreased and the vertebral height increased in the two groups at 1 day and 6 months after operation,but the change was more significant in the observation group( P < 0. 05). The ODI of the two groups at 6 months after operation was significantly lower than that before operation,and the ODI of the observation group at 6 months after operation was significantly lower than that of the control group( P < 0. 05). Conclusion Hyperextension traction elastic pressure combined with percutaneous pedicle screw fixation for thoracolumbar fracture has a good clinical effect,which can not only promote fracture reduction,but also improve the life ability of patients.
Objective To investigate the clinical effect of hyperextension traction elastic pressure combined with percutaneous pedicle screw fixation in treatment of thoracolumbar fracture. Methods According to different treatment methods,97 patients with single segment thoracolumbar fracture were divided into the observation group of 48 cases and the control group of 49 cases. The patients in the control group were treated with percutaneous pedicle screw fixation,while patients in the observation group were treated with hyperextension traction elastic pressure combined with percutaneous pedicle screw fixation. The operation time,intraoperative bleeding volume,ambulation time,hospitalization time,visual analogue scale of pain( VAS) before operation,1 day after operation and 6 months after operation,Cobb's angle of sagittal kyphosis of injured vertebrae and vertebral height,Oswestry dysfunction index( ODI) before and 6 months after operation was compared between the two groups. Results There were no significant differences in the operation time,intraoperative bleeding volume,ambulation time or hospitalization time between the two groups( all P > 0. 05). The VAS and Cobb's angle of sagittal kyphosis of the injured vertebrae decreased and the vertebral height increased in the two groups at 1 day and 6 months after operation,but the change was more significant in the observation group( P < 0. 05). The ODI of the two groups at 6 months after operation was significantly lower than that before operation,and the ODI of the observation group at 6 months after operation was significantly lower than that of the control group( P < 0. 05). Conclusion Hyperextension traction elastic pressure combined with percutaneous pedicle screw fixation for thoracolumbar fracture has a good clinical effect,which can not only promote fracture reduction,but also improve the life ability of patients.
引文
[1]张君.经皮椎弓根螺钉内固定术治疗胸腰椎骨折的临床疗效观察[J].中国矫形外科杂志,2017,25(2):187-189.
[2]吴寅良,王强,彭俊,等.高黏度骨水泥经皮椎体成形术治疗老年患者骨质疏松性胸腰椎骨折的效果[J].广东医学,2016,37(11):1669-1671.
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[4]冯华龙,赖居易,黄飞强.过伸牵引弹性按压联合经皮椎弓根钉内固定治疗胸腰椎骨折的生物力学差异[J].中国组织工程研究,2017,21(23):3676-3681.
[5]张军,杨淮河,徐亚平,等.经皮微创椎弓根螺钉内固定与开放手术治疗胸腰椎骨折椎体前缘高度和Cobb's角的比较[J].临床和实验医学杂志,2016,15(7):690-692.
[6]陈磊,荆珏华,钱军,等.经皮与开放椎弓根钉棒跨伤椎内固定治疗胸腰椎骨折[J].实用骨科杂志,2018,24(3):201-204.
[7]刘俊涛,王小勇,黄建军,等.经皮微创椎弓根钉技术与切开复位内固定治疗胸腰椎骨折的疗效比较[J].中国骨与关节损伤杂志,2016,31(1):71-73.
[8]闫廷飞,孙晨曦,杨勇,等.胸腰椎骨折的治疗进展[J].中国矫形外科杂志,2017,25(12):1113-1116.
[9]王珣,陈远明,黄中飞,等.经伤椎置钉内固定治疗胸腰椎骨折的研究进展[J].广西医学,2018,40(3):322-325.
[10]管礼安,谭永超,成业东.胸腰椎骨折分型及开放性手术治疗的研究进展[J].颈腰痛杂志,2016,37(4):336-339.
[11]宗路杰,袁振.经皮椎弓根螺钉治疗胸腰椎骨折的研究进展[J].医学综述,2017,23(20):4094-4099.
[12]刘宁,王盛海,李维,等.微创经皮经伤椎椎弓根钉内固定治疗无神经损伤胸腰椎骨折[J].中国骨与关节损伤杂志,2017,32(7):728-729.
[13]叶彬,陈令斌,陈伟,等.经皮微创单向实心椎弓根钉内固定治疗胸腰椎骨折[J].中国组织工程研究,2017,21(27):4312-4317.
[14]黄常盛,王剑,吕正涛,等.体位结合手法复位经皮椎弓根螺钉内固定治疗胸腰椎骨折效果观察[J].当代医学,2016,22(16):72-73.
[15]胡敏,李光胜,刘知泉.三步正骨法结合椎弓根螺钉内固定术治疗屈曲型胸腰椎骨折的临床研究[J].成都中医药大学学报,2016,39(2):101-103.
[16]茶晓锋,唐中尧,周琴.三步复位法整复单纯胸腰椎骨折临床研究[J].新中医,2016,48(6):119-121.
[17]陈华,李宇卫,姜宏.非手术疗法治疗单纯性胸腰椎骨折的研究进展[J].中医正骨,2017,29(7):48-50.
[18]李长青,张伟.经皮椎弓根螺钉固定技术在胸腰椎骨折中的应用[J].创伤外科杂志,2017,19(7):559-561.
[2]吴寅良,王强,彭俊,等.高黏度骨水泥经皮椎体成形术治疗老年患者骨质疏松性胸腰椎骨折的效果[J].广东医学,2016,37(11):1669-1671.
[3]钟泽莅,万盛钰,谭伦,等.光电导航下经皮椎弓根螺钉复位内固定和开放后路椎弓根螺钉复位内固定治疗胸腰椎骨折[J].中国组织工程研究,2017,21(23):3718-3723.
[4]冯华龙,赖居易,黄飞强.过伸牵引弹性按压联合经皮椎弓根钉内固定治疗胸腰椎骨折的生物力学差异[J].中国组织工程研究,2017,21(23):3676-3681.
[5]张军,杨淮河,徐亚平,等.经皮微创椎弓根螺钉内固定与开放手术治疗胸腰椎骨折椎体前缘高度和Cobb's角的比较[J].临床和实验医学杂志,2016,15(7):690-692.
[6]陈磊,荆珏华,钱军,等.经皮与开放椎弓根钉棒跨伤椎内固定治疗胸腰椎骨折[J].实用骨科杂志,2018,24(3):201-204.
[7]刘俊涛,王小勇,黄建军,等.经皮微创椎弓根钉技术与切开复位内固定治疗胸腰椎骨折的疗效比较[J].中国骨与关节损伤杂志,2016,31(1):71-73.
[8]闫廷飞,孙晨曦,杨勇,等.胸腰椎骨折的治疗进展[J].中国矫形外科杂志,2017,25(12):1113-1116.
[9]王珣,陈远明,黄中飞,等.经伤椎置钉内固定治疗胸腰椎骨折的研究进展[J].广西医学,2018,40(3):322-325.
[10]管礼安,谭永超,成业东.胸腰椎骨折分型及开放性手术治疗的研究进展[J].颈腰痛杂志,2016,37(4):336-339.
[11]宗路杰,袁振.经皮椎弓根螺钉治疗胸腰椎骨折的研究进展[J].医学综述,2017,23(20):4094-4099.
[12]刘宁,王盛海,李维,等.微创经皮经伤椎椎弓根钉内固定治疗无神经损伤胸腰椎骨折[J].中国骨与关节损伤杂志,2017,32(7):728-729.
[13]叶彬,陈令斌,陈伟,等.经皮微创单向实心椎弓根钉内固定治疗胸腰椎骨折[J].中国组织工程研究,2017,21(27):4312-4317.
[14]黄常盛,王剑,吕正涛,等.体位结合手法复位经皮椎弓根螺钉内固定治疗胸腰椎骨折效果观察[J].当代医学,2016,22(16):72-73.
[15]胡敏,李光胜,刘知泉.三步正骨法结合椎弓根螺钉内固定术治疗屈曲型胸腰椎骨折的临床研究[J].成都中医药大学学报,2016,39(2):101-103.
[16]茶晓锋,唐中尧,周琴.三步复位法整复单纯胸腰椎骨折临床研究[J].新中医,2016,48(6):119-121.
[17]陈华,李宇卫,姜宏.非手术疗法治疗单纯性胸腰椎骨折的研究进展[J].中医正骨,2017,29(7):48-50.
[18]李长青,张伟.经皮椎弓根螺钉固定技术在胸腰椎骨折中的应用[J].创伤外科杂志,2017,19(7):559-561.
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