皮外适度撑开联合上半身反弓技术后路短节段伤椎经皮椎弓根螺钉内固定治疗胸腰段骨折的临床研究

Clinical study of percutaneous pedicle screw fixation in treatment of thoracolumbar fracture with posterior short segment injury combined with upper body reverse arch technique

摘要:

目的 探讨皮外适度撑开联合上半身反弓技术后路短节段伤椎经皮椎弓根螺钉内固定治疗胸腰段骨折的临床疗效。方法 选取2020年1月—2022年1月九江市第一人民医院收治的60例胸腰段骨折患者，根据随机数字表法分为两组，每组30例。研究组接受皮外适度撑开联合上半身反弓技术后路短节段伤椎经皮椎弓根螺钉内固定治疗，对照组接受切开复位椎弓根螺钉内固定治疗。比较两组患者的手术指标和手术前后伤椎前缘高度比、矢状面Cobb角、视觉模拟评分法（VAS）评分、Oswestry功能障碍指数（ODI）及术后并发症发生率。结果 研究组的手术时间、术后住院时间短于对照组（P <0.05），切口长度小于对照组（P <0.05），术中出血量低于对照组（P <0.05）。研究组手术前后伤椎前缘高度比的差值高于对照组（P <0.05），矢状面Cobb角的下降程度大于对照组（P <0.05）。研究组手术前后VAS评分和ODI评分的下降程度大于对照组（P <0.05）。研究组术后未发生并发症，对照组术后出现3例伤口感染，1例伤口延迟愈合，2例矫正度丢失，并发症发生率为20.00％；研究组术后并发症发生率低于对照组（P <0.05）。结论 与传统切开复位椎弓根螺钉内固定治疗相比，皮外适度撑开联合上半身反弓技术后路短节段伤椎经皮椎弓根螺钉内固定治疗胸腰段骨折能缩短手术时间、术后住院时间，降低术中出血量和疼痛程度，促进患者功能康复，且安全性高，值得临床推广。

Abstract:

Objective To investigate the clinical efficacy of percutaneous pedicle screw fixation in the treatment of thoracolumbar fracture with posterior short segment extension combined with upper body respital technique.Methods A total of 60 patients with thoracolumbar fracture admitted to our hoer table method from January 2020 to January 2022 were divided into two groups according to the random numbverse arch. Thirty cases in the study group received percutaneous pedicle screw internal fixation treatment for posterior short segment injuries combined with upper body reverse arch technique, and 30 cases in the control group received incisional reduction pedicle screw internal fixation treatment. The surgical index, anterior edge height ratio, sagittal Cobb angle, visual analogue scale (VAS) score, Oswestry dysfunction index (ODI), and postoperative complication rate were compared between the two groups.Results The operation time (P < 0.05) and postoperative hospital stay (P < 0.05) of the study group were shorter than those of the control group, the incision length was shorter than that of the control group (P < 0.05), and the intraoperative blood loss was lower than that of the control group (P < 0.05). The difference of the height ratio of the injured vertebral front before and after surgery in the study group was higher than that in the control group (P < 0.05), and the reduction degree of the sagittal plane Cobb angle was greater than that in the control group (P < 0.05). The decrease of VAS score and ODI score in the study group before and after surgery was greater than that in the control group (P < 0.05). There were no postoperative complications in the study group (0/30). In the control group, there were 3 cases of wound infection, 1 case of delayed wound healing, and 2 cases of loss of correction, the incidence of complications was 20.00% (6/30). The incidence of postoperative complications in the study group was lower than that in the control group (P < 0.05).Conclusion Compared with the traditional incisional reduction pedicle screw internal fixation treatment, the treatment of thoracolumbar fracture with percutaneous pedicle screw internal fixation of posterior short segment injury combined with upper body reverse arch technique can shorten the operation time, postoperative hospital stay, reduce the amount of intraoperative bleeding and pain, promote the functional recovery of patients, and is worthy of clinical promotion.