[1]曲泊霖,王江波,曹 剑,等.体位手法复位联合经皮置钉内固定术治疗无神经症状胸腰椎骨折临床研究[J].陕西医学杂志,2022,51(7):811-815.[doi:DOI:10.3969/j.issn.1000-7377.2022.07.010]
　QU Bolin,WANG Jiangbo,CAO Jian,et al.Clinical effect of postural and manual reduction combined with percutaneous pedicle screw fixation in treatment of thoracolumbar fracture without neurological symptoms[J].,2022,51(7):811-815.[doi:DOI:10.3969/j.issn.1000-7377.2022.07.010]
点击复制

体位手法复位联合经皮置钉内固定术治疗无神经症状胸腰椎骨折临床研究
分享到：

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
51
期数:
2022年7期
页码:
811-815
栏目:
临床研究
出版日期:
2022-07-05

文章信息/Info

Title:
Clinical effect of postural and manual reduction combined with percutaneous pedicle screw fixation in treatment of thoracolumbar fracture without neurological symptoms
作者:
曲泊霖1; 2; 王江波2; 曹 剑2; 鲍志磊2; 郑德宇3
(1.锦州医科大学赤峰学院研究生培养基地,内蒙古 赤峰 024005; 2.赤峰学院附属医院骨科,内蒙古 赤峰 024099; 3.锦州医科大学,辽宁 锦州121001)
Author(s):
QU Bolin; WANG Jiangbo; CAO Jian; BAO Zhilei; ZHENG Deyu
(Postgraduate Training Base,Chifeng University,Jinzhou Medical University,Chifeng 024005,China)
关键词:
胸腰椎骨折;  体位复位;  手法复位;  经皮置钉内固定;  无神经症状;  X线暴露
Keywords:
Thoracolumbar fracture;  Postural reduction;  Manual reduction;  Percutaneous pedicle screw fixation;  Without neurological symptoms;  X-ray exposure
分类号:
R 683.2
DOI:
DOI:10.3969/j.issn.1000-7377.2022.07.010
文献标志码:
A
摘要:
目的:比较体位手法复位联合经皮置钉内固定术与后路切开复位椎弓根钉内固定术治疗胸腰椎骨折的临床研究。方法:回顾性分析83例单节段无神经症状的胸腰椎骨折病人,其中微创组治疗43例患者采用体位手法复位联合经皮置钉内固定术,开放组治疗40例患者采用后路切开复位椎弓根钉内固定术。比较两组相关临床资料。结果:两组病例手术均顺利完成,所有患者均获得有效随访。微创组术中出血量、手术时间、术后初次下床活动时间、术后住院时间均显著少于开放组(均P<0.05); 微创组术中X线暴露次数显著多于开放组(P<0.05)。微创组术后3 d、术后3个月、术后6个月VAS评分显著低于开放组(均P<0.05); 两组术后Cobb角和椎体前缘高度与同组术前相比较,Cobb角显著减小、椎体前缘高度显著增高(均P<0.05),但两组间术后Cobb角恢复值和丢失值,椎体前缘高度恢复率和丢失率相比较差异无统计学意义(均P>0.05)。两组术后并发症相比较差异有统计学意义(P<0.05),两组总住院费用相比较差异无统计学意义(P>0.05)。结论:两种手术方式均能够有效治疗胸腰椎骨折,但体位手法复位联合经皮置钉内固定术具有微创出血少、手术时间短、术后恢复快等优势,另外还要关注术中X线暴露次数对医患造成的不良影响。
Abstract:
Objective:To compare the clinical effect of postural and manual reduction combined with percutaneous pedicle screw fixation and open reduction with internal fixation in the treatment of thoracolumbar fracture without neurological symptoms.Methods:A total of 83 cases of thoracolumbar fractures with single segment and no neurological symptoms were analyzed retrospectively.Among them,43 cases in the minimally invasive group were treated with postural and manual reduction combined with percutaneous pedicle screw fixation,and 40 cases in the open group were treated with open reduction and internal fixation.The clinical data of the two groups were compared.Results:The operation was successfully completed in both groups.All the patients were followed up effectively.The volume of intraoperative blood loss,operation time,postoperative initial ambulation time,and postoperative hospital stay in the minimally invasive group were significantly lower than those in the open group,and the number of intraoperative X-ray exposures was significantly higher than that in the open group(all P<0.05).The VAS scores of the minimally invasive group 3 days,3 months,and 6 months after operation were significantly lower than those in the open group(all P<0.05).The Cobb angle and the height of anterior vertebral border of the two groups were significantly reduced and the height of anterior vertebral border in two groups was significantly higher than that of the same group before operation(all P<0.05),but there was no significant difference in the recovery and loss of Cobb angle and the height of anterior vertebral border between the two groups(all P>0.05).There was significant difference in postoperative complication between the two groups(P<0.05),but there was no significant difference in total hospitalization expense between the two groups(P>0.05).Conclusion:Both surgical methods can effectively treat thoracolumbar fractures,but postural and manual reduction combined with percutaneous pedicle screw fixation has the advantages of less bleeding,shorter operation time and faster postoperative recovery.In addition,attention should be paid to the adverse effects of intraoperative X-ray exposure on doctors and patients.

参考文献/References:

[1] 白长双,王法佳,戴尚轶,等.经皮与开放椎弓根钉固定胸腰椎骨折的比较[J].中国矫形外科杂志,2020,28(12):1098-1103.
[2] Wood KB,Buttermann GR,Phukan R,et al.Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit:A prospective randomized study with follow up at sixteen to twenty two years[J].J Bone Joint Surg Br,2015,97(1):3-9.
[3] Defino H,Costa H,Nunes AA,et al.Open versus minimally invasive percutaneous surgery for surgical treatment of thoracolumbar spine fractures- a multicenter randomized controlled trial:Study protocol[J].BMC Musculoskeletal Disorders,2019,20(1):397.
[4] 吴溢峰,谭洁詠,吴焯鹏,等.经皮与开放椎弓根钉内固定治疗胸腰椎骨折的疗效比较[J].中国微创外科杂志,2020,20(11):982-986.
[5] 谭志红,潘 丹,陈大勇,等.经皮实心椎弓根螺钉治疗无神经损伤胸腰段骨折的疗效[J].临床骨科杂志,2021,24(2):164-169.
[6] 张波波,宋忠伟,黎巧玲,等.经皮椎弓根螺钉与Wiltse入路复位内固定术治疗无神经症状胸腰椎骨折的疗效对比[J].西安交通大学学报:医学版,2022,43(1):57-62.
[7] 吴 卓,贺西京,王自立,等.不同入路椎弓根钉内固定术治疗胸腰椎骨折临床疗效比较[J].陕西医学杂志,2022,51(4):415-418.
[8] 王文涛,段 琨,王欣文,等.体位复位经皮微创椎弓根螺钉内固定治疗无神经症状的胸腰椎重度压缩骨折[J].骨科,2017,8(1):34-38.
[9] 罗 鹏,徐良丰,倪文飞,等.经皮椎弓根内固定治疗胸腰椎骨折的效果及并发症分析[J].中华外科杂志,2011,49(2):130-134.
[10] 张海平,郝定均,贺宝荣,等.经皮微创复位内固定术治疗胸腰椎骨折的并发症[J].脊柱外科杂志,2018,16(6):344-348.
[11] 宋正东,宋文慧,刘昌文,等.胸腰椎爆裂骨折术后椎体“空壳”体积变化的相关因素分析[J].中国脊柱脊髓杂志,2018,28(11):1011-1019.
[12] 胡海刚,林 旭,谭 伦,等.胸腰椎骨折后椎体“空壳”现象的手术治疗策略[J].中国修复重建外科杂志,2019,33(1):49-55.
[13] 蒋国华,孙贤杰,张新根,等.脊柱爆裂性骨折患者治疗后椎体空壳体积改变的影响因素研究[J].中国预防医学杂志,2020,21(5):523-527.
[14] Ye H,Chen QX.Comparative study of minimally invasive percutaneous pedicle screw fixation and open surgery in the treatment of thoracolumbar fractures[J].Zhongguo Gu Shang,2017,30(2):105-109.
[15] 卢 洋,王 瑜,李征宇,等.经皮微创椎弓根钉内固定术治疗无神经损伤不稳定胸腰椎骨折疗效临床观察[J].陕西医学杂志,2019,48(9):1151-1154.
[16] 田 野,张嘉男,陈 浩,等.脊柱机器人与传统透视辅助下微创经皮复位内固定术治疗单节段无神经症状胸腰椎骨折对比研究[J].中国修复重建外科杂志,2020,20(1):69-75.
[17] 易国良,宋西正,王文军,等.网格定位板在经皮椎弓根微创手术进钉点定位中的应用[J].中国组织工程研究,2017,21(15):2366-2371.
[18] 方晓辉,吴一雄,胡辉东,等.改良金属网格定位器经皮微创椎弓根螺钉内固定术治疗无神经症状胸腰椎骨折[J].脊柱外科杂志,2019,17(6):388-393.
[19] 刘 寰.基于增强现实技术的微创脊柱外科手术引导系统的创新设计与应用研究[D].重庆:中国人民解放军陆军军医大学,2020.
[20] Fabio M,Simon R,Florentin L,et al.Augmented reality navigation for spinal pedicle screw instrumentation using intraoperative 3D imaging[J].The Spine Journal,2020,20(4):621-628.

相似文献/References:

[1]穆佐洲,邵海龙.手术入路对骨质疏松性胸腰椎骨折术后并发症的影响及术后再骨折危险因素分析[J].陕西医学杂志,2022,51(7):848.[doi:DOI:10.3969/j.issn.1000-7377.2022.07.019]
[2]李小龙,葛郁龙.经皮钉棒内固定和Wiltse入路切开复位钉棒内固定治疗胸腰椎骨折疗效及对患者椎体形态、创伤因子的影响[J].陕西医学杂志,2022,51(8):986.[doi:DOI:10.3969/j.issn.1000-7377.2022.08.019]
　LI Xiaolong,GE Yulong.Efficacy of percutaneous nail-rod internal fixation and Wiltse approach open reduction nail-rod internal fixation for thoracolumbar fractures and its influence on vertebral body morphology and trauma factor levels in patients[J].,2022,51(7):986.[doi:DOI:10.3969/j.issn.1000-7377.2022.08.019]

备注/Memo

备注/Memo:
基金项目:内蒙古自治区自然科学基金资助项目(2021LHMS08025)
更新日期/Last Update: 2022-07-05