经皮椎弓根螺钉固定治疗胸腰段A3型骨折的临床观察

目的　比较经皮椎弓根螺钉固定和开放式椎弓根螺钉固定治疗胸腰段A3型骨折的临床疗效。 方法　收集我院胸腰段脊柱骨折35例临床资料，所有病例均为没有神经症状，AO分型为A3型骨折。其中观察组18例患者，均行短节段联合伤椎经皮椎弓根螺钉内固定，对照组17例患者，均行开放式短节段联合伤椎椎弓根螺钉内固定。通过VAS疼痛评分、总体满意度评价、影像学随访（VBI评分、VBA评分、Cobb角）来比较两组临床疗效。 结果　观察组的平均手术时间为(53±10)min，对照组的平均手术时间为(90±9) min（P＜0.05）。观察组术中出血量(56±17) ml，对照组术中出血量(331±149) ml（P＜0.001）。观察组在术后7 d的VAS评分显著低于对照组（P＜0.001）。术后随访VBI评分、VBA评分和Cobb角在两组中没有显著差异（P＞0.05）。 结论　短节段联合伤椎经皮椎弓根螺钉固定是治疗胸腰段A3型脊柱骨折的优先选择之一，具有术中出血量少、术后疼痛轻、恢复快、手术时间短等主要优势，值得临床推广。

The clinical observation about percutaneous pedicle screws in treatment of Type A3 thoracolumbar fracture

Objective　To compare the clinical effects of type A3 thoracolumbar fracture percutaneous pedicle screws fixation and open pedicle screw fixation．Methods 35 patients who had AO classification type A3 thoracolumbar spine fracture and without neurological symptoms in our department were enrolled in the research.18 patients in the observation group accepted short segment combined with intermediate percutaneous pedicle screws fixation;17 patients in the control group accepted open pedicle screw fixation. The VAS score、overall satisfaction、radiographic follow-up （VBI score、VBA score、Cobb’s Angle）were compared between two groups withtheclinicaleffect. Results The average surgical duration in the observation group(percutaneous pedicle screws fixation) was (53±10) min, in the control group(open pedicle screw fixation) was (90±9) min（P＜0.05）.The bleeding during the operation of the observation group was (56±17) ml, the control group was (331±149) ml（P＜0.001）. There was no significant difference in the VBI score、VBA score and Cobb’s Angle at postoperative follow-up (P > 0.05 )． Conclusion This research is showing that the short segment combined with intermediate percutaneous pedicle screws fixation is a preferred treatment of Type A3 thoracolumbar spine fracture，which has the advantages of less bleeding, light pain, quick recovery and short surgical duration.