不同手術方法治療胸腰椎骨折的臨床療效比較

尚福亮+陳華+李斌+李廣慶

[摘要] 目的 探討比較不同手術方法治療胸腰椎骨折的臨床效果。方法 方便選取2014年6月—2016年7月期間在該院進行診斷治療的胸腰椎骨折且符合手術指征的患者120例，按手術方法不同隨機平均分為治療組1、治療組2和治療組3，每組40例。分別行經皮椎體成形術、椎體后凸成形術和微創經皮椎弓根螺釘內固定術。觀察3組患者術后病情進展，評估療效，并分析不同方法的利弊。結果 治療組1平均手術時間最短，為（0.45±0.20）h，平均骨水泥注入量（3.1±1.50）mL，較節約成本；治療組2術中失血量少，平均失血量為（15.7±2.60）mL，骨水泥滲漏率10.0%，療效較好；治療組3手術創口微小，但手術時間較長；3組患者手術情況比較差異有統計學意義（P<0.05）；3組患者術后均有不同程度的癥狀緩解，脊柱減壓有效率均>70.0%，患者術后椎體高度均有上升，VAS評分分數均有下降，表明手術治療效果良好，但3組患者脊柱減壓有效率、椎體平均高度、VAS評分方面比較差異無統計學意義（P>0.05）。結論 經皮椎體成形術、椎體后凸成形術和微創經皮椎弓根螺釘內固定術對于治療胸腰椎骨折均有良好的臨床效果，經皮椎體成形術手術時間短、耗材少，椎體后凸成形術術中失血量少、骨水泥滲漏率低，微創經皮椎弓根螺釘內固定術創口小，療效明顯。臨床治療應根據病情指征選擇合適的手術方法。

[關鍵詞] 經皮椎體成形術；椎體后凸成形術；微創經皮椎弓根螺釘內固定術；胸腰椎骨折；臨床療效比較

[中圖分類號] R687 [文獻標識碼] A [文章編號] 1674-0742（2017）02（b）-0057-03

[Abstract] Objective To discuss the clinical effect of different operation methods in treatment of thoracolumbar fractures. Methods 120 cases of patients with thoracolumbar fractures and meeting the operation signs in our hospital from June 2014 to July 2016 were convenient selected and randomly divided into three groups with 40 cases in each according to different operation methods， the treatment group 1 were treated with percutaneous vertebroplasty， the treatment group 2 were treated with kyphonplasty， the treatment group 3 were treated with percutaneous pedicle screw fixation operation， and the postoperative disease progress of the three groups was observed and the curative effect was evaluated and the advantages and disadvantages of different methods were analyzed. Results The average operation time in the treatment group 1 was the shortest， （0.45±0.20）h， and the average amount of bone cement injection was （3.1±1.50）mL， and in the treatment group 2， the intraoperative blood loss was less， and the average blood loss was （15.7±2.60）mL， and the leakage rate of bone cement was 10.0%， and the curative effect was good， in the treatment group 3， the operation wound is small， but the operation time was longer， and the difference in the operation condition between the three groups had statistical significance（P<0.05）， and the symptoms of the three groups were relieved in different degrees， and the effective rate of spinal decompression >70.0%， and the postoperative vertebral height was improved， and the VAS score was decreased， which shows that the operation treatment effect is good， but the difference in the effective rate of spinal decompression， average centrum height and VAS score had no statistical significance（P>0.05）. Conclusion The clinical effect of percutaneous vertebroplasty， kyphonplasty and percutaneous pedicle screw fixation operation is good， and the operation time of percutaneous vertebroplasty is shorter and the materials are fewer， and the blood loss of kyphonplasty is less and the leakage rat of bone cement is lower， and the wound of percutaneous pedicle screw fixation operation is small and the curative effect is obvious， and we should select the suitable operation method in the clinical treatment according to the disease indications.

[Key words] Percutaneous vertebroplasty； Kyphonplasty； Percutaneous pedicle screw fixation operation； Thoracolumbar fractures； Comparison of clinical curative effect

胸腰椎骨折是指由于外力造成胸腰椎骨質連續性的破壞，是一種最常見的脊柱損傷。病……