經(jīng)皮椎弓根置釘內(nèi)固定治療成年人AO-A型胸腰椎骨折的臨床觀察

楊忠義　謝勝榮　董迎春　李杰　茍琦　徐盈舒　李旭

摘要：目的 ?探討經(jīng)皮椎弓根置釘治療成年人AO-A型胸腰椎骨折的臨床療效。方法 ?回顧性分析2015年1月～2019年2月我院骨科成年人胸腰椎A(chǔ)型骨折病例82例，根據(jù)治療方法分為保守治療組（26例）及手術(shù)治療組（56例），手術(shù)治療組行經(jīng)皮微創(chuàng)置釘手術(shù)治療，比較兩組出院時以及手術(shù)治療組入院時、術(shù)后1、3個月VAS評分、ODI指數(shù)、傷椎后凸Cobb角、傷椎前緣高度及臥床時間。結(jié)果 ?手術(shù)治療組出院時VAS評分、ODI指數(shù)、后凸Cobb角、傷椎前緣高度分別為（1.68±0.81）分、（37.51±6.81）、（5.79±4.56）°、（86.81±9.32）%，均優(yōu)于保守治療組的（3.13±1.06）分、（55.93±7.92）、（18.60±8.96）°、（60.30±15.42）%，差異有統(tǒng)計學(xué)意義（P<0.05）;手術(shù)治療組入院時、術(shù)后1、3個月VAS評分、ODI 指數(shù)、傷椎后凸Cobb角、傷椎前緣高度比較，差異均有統(tǒng)計學(xué)意義（P<0.05）。結(jié)論 ?經(jīng)皮椎弓根置釘內(nèi)固定是治療成年人A型胸腰椎骨折的有效方法，與保守治療相比，經(jīng)皮椎弓根置釘內(nèi)固定臥床時間短，傷椎后凸Cobb角、傷椎前緣高度改善效果更好。

關(guān)鍵詞：胸腰椎骨折;經(jīng)皮椎弓根固定;AO-A型骨折

中圖分類號：R687.3 ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?文獻(xiàn)標(biāo)識碼：A ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?DOI：10.3969/j.issn.1006-1959.2020.18.024

文章編號：1006-1959（2020）18-0080-03

Clinical Observation of Percutaneous Pedicle Screw Fixation in the Treatment of

Adult AO-A Thoracolumbar Fractures

YANG Zhong-YI，XIE Sheng-rong，DONG Ying-chun，LI Jie，GOU Qi，XU Ying-shu，LI Xu

（Department of Orthopedics，the First People's Hospital of Longquanyi District，Chengdu 610100，Sichuan，China）

Abstract：Objective ?To investigate the clinical effect of percutaneous pedicle screw placement in the treatment of adult AO-A thoracolumbar fractures.Methods ?A retrospective analysis of 82 cases of adult thoracolumbar fractures of the orthopedics department in our hospital from January 2015 to February 2019 were divided into conservative treatment group （26 cases） and surgical treatment group （56 cases） according to the treatment method，the surgical treatment group underwent percutaneous minimally invasive nail placement surgery. The two groups were compared when they were discharged from the hospital and when the surgical treatment group was admitted，VAS score， ODI index， Cobb angle of kyphosis， height of the anterior edge of the injured vertebrae， and time in bed at 1 and 3 months after operation.Results ?The VAS score， ODI index， Cobb angle of kyphosis， and the height of the anterior edge of the injured vertebra at discharge in the surgical treatment group were （1.68±0.81） points， （37.51±6.81）， （5.79±4.56）°， （86.81±9.32）%， respectively，all were better than the conservative treatment group's （3.13±1.06） points， （55.93±7.92）， （18.60±8.96）°， （60.30±15.42）%， the difference was statistically significant （P<0.05）;There were statistically significant differences in the VAS score， ODI index， Cobb angle of the kyphotic spine， and the height of the anterior edge of the spine in the surgical treatment group at admission， 1 and 3 months after the operation （P<0.05）.Conclusion ?Percutaneous pedicle screw fixation was an effective method for the treatment of adult type A thoracolumbar fractures. Compared with conservative treatment， percutaneous pedicle screw fixation had shorter bed time， kyphotic Cobb angle and injury. The effect of improving the height of the anterior edge of the vertebra was better.

Key words：Thoracolumbar fractures;Percutaneous pedicle fixation;AO-A fractures

胸腰椎骨折（thoracolumbar fractures）是臨床最常見的脊柱損傷，占脊柱外傷的90%[1]。目前臨床普遍采用AO分型對胸腰椎骨折進(jìn)行分型，對其中A型骨折治療長期以來存有爭議。無神經(jīng)損害的A型骨折可采取保守治療，但保守治療臥床時間長，存在臥床并發(fā)癥的風(fēng)險，患者無法快速康復(fù)，生活質(zhì)量較低[2]。傳統(tǒng)后路切開復(fù)位椎弓根螺釘內(nèi)固定是臨床治療胸腰椎骨折的有效方法，但有手術(shù)創(chuàng)傷大，并發(fā)癥多，恢復(fù)慢等缺點[3，4]。近年來隨著脊柱微創(chuàng)技術(shù)的發(fā)展，經(jīng)皮椎弓根置釘逐漸被應(yīng)用于治療成年人胸腰椎骨折，具有手術(shù)創(chuàng)傷小，出血少，恢復(fù)快等優(yōu)點。研究發(fā)現(xiàn)對于AO-A型胸腰椎骨折，采用經(jīng)皮椎弓根置釘內(nèi)固定治療臨床療效滿意，相對于保守治療后者存在部分優(yōu)點，本研究對我院骨科82例AO-A型胸腰椎骨折進(jìn)行治療，現(xiàn)報道如下。……