经皮椎弓根钉棒微创内固定系统结合伤椎植骨 治疗胸腰椎骨折的临床效果

Percutaneous pedicle screw rod minimally-invasive internal fixation system combined with bone graft of injured vertebrae for treatment of thoracolumbar fractures

摘要:

目的 探讨经皮椎弓根钉棒微创内固定系统结合经椎弓根伤椎椎体内植骨治疗胸腰椎骨折的临床 疗效。方法 2015 年2 月-2016 年1 月安徽医科大学第一附属医院骨科无需减压的胸腰椎骨折患者40 例，随 机分为两组，观察组20 例在“C”型臂透视引导下应用微创内固定系统结合伤椎椎体内植骨治疗；对照组20 例切开复位椎弓根内固定取髂骨植骨治疗，比较两组患者的临床参数和影像学指标。结果 两组患者均顺利 完成手术，获得随访13 ～ 24 个月，观察组和对照组术后伤椎Cobb's 角低于术前（P <0.05）；观察组和对照 组术后椎体前缘高度高于术前（P <0.05）。观察组术中出血量优于对照组（P <0.05）；观察组的手术时间优 于开放组（P <0.05）；观察组术后引流量优于对照组（P <0.05）；观察组的术后胸腰段Cobb's 角（过屈位/ 过伸位）优于对照组（P <0.05），且观察组术后伤椎均未出现“蛋壳”效应。结论 经皮椎弓根钉棒微创系统 结合伤椎植骨治疗胸腰椎骨折手术创伤小、出血少、安全可靠、矫正效果满意、术后恢复快、保留胸腰段活 动度，并有效防止伤椎出现“蛋壳”效应，能够即刻增加伤椎椎体的骨容量及前柱的抗压稳定性，值得临床推广。

Abstract:

Objective To explore the clinical curative effect of percutaneous pedicle screw rod minimallyinvasive internal fixation system combined with transpedicular intravertebral bone graft of injuried vertebrae for the treatment of thoracolumbar fractures. Methods From February 2015 to January 2016, 40 patients of thoracolumbar fractures without decompression were treated in the Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University. The patients were randomly divided into 2 groups, the 20 cases of the observation group were treated by minimally-invasive internal fixation system in combination with intravertebral bone graft of injured vertebrae under the guidance of type “C” arm fluoroscopy, the 20 cases of the control group received open reduction and pedicle internal fixation with iliac bone graft treatment. Clinical parameters and radiographic indexes were compared between the two groups. Results In both groups the surgery was successfully completed, and the patients were followed up for 13-24 months. In both groups, the Cobb angles of the injuried vertebrae after operation were smaller than those before operation (P < 0.05). In both groups the anterior flange height of the vertebrae after operation was higher than that before operation (P < 0.05). The intraoperative bleeding volume and postoperative drainage volume of the observation group was smaller than those of the control group (P < 0.05). The operating time of the observation group was shorter than that of the control group (P < 0.05). The postoperative Cobb angles of the thoracic lumbar segments in the observation group were smaller than those of the control group (P < 0.05). In the observation group the injuried vertebrae did not present “eggshell” effect. Conclusions In the treatment of thoracolumbar fractures, the percutaneous pedicle screw rod minimally-invasive system combined with bone graft of injuried vertebrae has the advantages of minimal surgical trauma, little bleeding, safety and reliability, satisfied corrective effect and quicker recovery, and can retain thoracic lumbar segment activity, and effectively prevent “eggshell” effect of injuried vertebrae, can immediately increase the bone volume of the injured vertebral bodies and the pressure stability of the anterior columns. It is worth clinical promotion.