椎弓根外穿刺撬拨复位椎弓根钉固定治疗胸腰椎骨折

目的探讨经椎弓根外穿刺撬拨复位椎弓根螺钉固定治疗胸腰骨折的可行性和有效性。方法回顾性分析2012年2月—2015年3月深圳平乐骨伤科医院收治的64例胸腰椎骨折患者,观察组和对照组各32例,观察组采用经椎弓根外穿刺撬拨复位、植骨、椎弓根钉内固定治疗,对照组采用椎弓根钉棒撑开复位固定、经伤椎椎弓根穿刺植骨治疗。记录手术时间、术中出血量、术后引流量、住院时间;测量术前、术后伤椎体前、后缘高度比和后凸Cobb角;同时对两组患者进行手术前、后VAS评分和Oswestry功能障碍指数评分。结果观察组与对照组相比较,术前VAS评分(6.782±1.821)%vs.(6.827±1.762)%]、术前伤椎体前缘高度百分比(57.658±23.645)%vs.(58.162±24.852)%]、术前伤椎体后缘高度百分比(88.645±8.624)%vs.(87.927±7.848)%]、术前后凸Cobb角(28.665±4.824)°vs.(29.134±5.508)°]、手术时间(135.675±23.318)min vs.(130.731±21.761)min]、术中出血量(456.214±63.525)m L vs.(461.532±60.753)m L]、术后引流量(43.847±16.358)m L vs.(42.971±15.523)m L]、住院时间(10.878±2.148)d vs.(11.323±2.512)d]、术后末次随访VAS评分(0.184±0.263 vs.0.195±0.325)和Oswestry功能障碍指数(2.463±0.652 vs.2.624±0.765),差异均无统计学意义(P0.05)。观察组与对照组相比较,术后末次随访伤椎体前缘高度百分比(98.083±1.635)%vs.(93.157±2.019)%、后缘高度百分比(98.504±2.572)%vs.(96.248±4.824)%]和后凸Cobb角(3.623±2.563)°vs.(7.626±3.613)°],差异均有统计学意义(P0.05)。结论经椎弓根外穿刺撬拨复位椎弓根螺钉固定治疗Denis B型、D型胸腰椎体压缩骨折、B型椎体爆裂骨折,可较好恢复椎体前、后缘高度,矫正后凸Cobb角。

The treatment of thoracic and lumbar vertebrae fracture by transpedicular puncturing and poking reduction and pedicle screw fixation

Objective To explore the feasibility and effectiveness of transpedicular puncturing and poking reduction and pedicle screw fixation for the treatment of thoracic and lumbar vertebrae fractures .Methods Sixty-four patients with thoracic and lumbar vertebrae fracture from Feb .2012-mar.2015 were retrospectively analyzed , and were divided into observation group and control group ,with 32 cases in each group .The observation group was treated by puncturing and poking reduction outside of the pedicle ,bone grafting and pedicle screw fixation .The con-trol group was treated by the traditional distraction reduction by pedicle screw fixation ,transpedicular puncture and bone grafting in injured vertebral body .The operation time , intraoperative bleeding volume , postoperative drainage and length of stay were recorded .Anterior and posterior vertebral height and kyphosis Cobb angle were measured , and VAS score and Oswestry disability index score were recorded in both groups before and after operation .Results The preoperative VAS score was ( 6.782 ±1.821 ) points in the observation group , and was ( 6.827 ±1.762 ) points in the control group; preoperative anterior height percentage of injured vertebral body was ( 57.658 ± 23.645)％ in the observation group ,and was (58.162 ±24.852 )％ in the control group; preoperative posterior height percentage of injured vertebral body was (88.645 ±8.624) ％in the observation group ,and was (87.927 ± 7.848)％in the control group,preoperative kyphosis Cobb angle was (28.665 ±4.824)°in the observation group, and was (29.134 ±5.508)°in the control group;operation time was (135.675 ±23.318) min in the observation group,and was (130.731 ±21.761) min in the control group; intraoperative bleeding volume was (456.214 ± 63.525) mL in the observation group ,and was (461.532 ±60.753) mL in the control group; postoperative drain-age was (43.847 ±16.358) mL in the observation group ,and was (42.971 ±15.523 ) mL in the control group;length of stay was (10.878 ±2.148) d in the observation group ,and was (11.323 ±2.512) d in the control group;postoperative VAS score was (0.184 ±0.263) points in the observation group ,and was (0.195 ±0.325) points in the control group and Oswestry disability index of final follow -up was(2.463 ±0.652 in the observation group ,and was (2.624 ±0.765) in the control group; all the indicators had no statistical difference between the observation group and the control group(P>0.05).The postoperative anterior height percentage of injured vertebral body (ob-servation group was 98.083 ±1.635,control group was 93.157 ±2.019),the postoperative posterior height percent-age of injured vertebral body (observation group was 98.504 ±2.572,control group was 96.248 ±4.824),and the postoperative kyphosis Cobb angle (observation group was 3.623 ±2.563°,control group was 7.626 ±3.613°)of fi-nal follow-up were found to have statistical differences between the observation group and the control group ( P<0.05).Conclusion Transpedicular puncturing and poking reduction and pedicle screw fixation for the treatment of Denis B and D thoracic and lumbar vertebral compression fractures and Denis B vertebral burst fractures can bet -ter restore the anterior and posterior vertebral height and correct the kyphosis Cobb angle .