李茂涛 程后庆

[摘要] 目的 分析经皮植入普通椎弓根螺钉治疗短节段无神经症状的胸腰椎骨折的临床应用效果。 方法 回顾性分析芜湖市中医院2014年1月至2020年1月接收的80例胸腰段骨折患者的临床资料，其中微创组采用经皮微创术式，开放组采用传统后路开放术式，每组各40例。比较两组手术时长、术中失血量、视觉模拟评分（VAS）、伤锥矢状面指数和椎体Cobb角变化。 结果 微创组的平均手术时间长于开放组，切口长度、术中出血量均少于开放组，差异有统计学意义（P<0.05），两组术后VAS评分比较，差异无统计学意义（P>0.05），两组手术对伤锥矢状面指数和椎体Cobb角的矫正比较，差异均无统计学意义（P>0.05）。 结论 微创植入普通椎弓根螺钉可以安全有效地治疗胸腰段骨折，虽相对开放组增加了手术时间，但能明显减少术中出血、手术切口长度，对治疗短节段胸腰椎骨折短期及中期内有明显的优势。

[关键词] 胸腰椎骨折;微创;椎弓根螺钉;开放手术

[中图分类号] R683.12          [文献标识码] B          [文章编号] 1673-9701（2021）32-0094-04

[Abstract] Objective To analyze the clinical effect of percutaneous implantation of ordinary pedicle screws in the treatment of short-segment thoracolumbar fractures without neurological symptoms. Methods A total of 80 patients with thoracolumbar fractures whose clinical data were retrospectively analyzed were admitted to Wuhu Hospital of Traditional Chinese Medicine from January 2014 to January 2020，including 40 cases in the minimally invasive surgery group （adopting percutaneous minimally invasive surgery） and 40 cases in the open surgery group（adopting traditional open surgery via posterior approach）. The operation time， intraoperative blood loss， visual analogue scale（VAS）， sagittal index of the fractured vertebra and Cobb angle change were compared between the two groups. Results The average operation time in the minimally invasive surgery group was longer than that in the open surgery group， and the incision length and intraoperative blood loss in the minimally invasive surgery group were shorter or less than those in the open surgery group， with statistically significant differences（P<0.05）. There was no statistically significant difference in the VAS scores after surgery between the two groups（P>0.05）. There was no statistical significance in the correction of sagittal index of the fractured vertebra and Cobb angle for the surgery in the two groups（P>0.05）. Conclusion Minimally invasive implantation of ordinary pedicle screws can safely and effectively treat thoracolumbar fractures. Although the operation time is increased compared with the open surgery group， minimally invasive surgery can significantly reduce intraoperative blood loss and surgical incision length. It has obvious advantages in the treatment of short-segment thoracolumbar fractures in the short and medium term.

[Key words] Thoracolumbar fractures; Minimally invasive; Pedicle screw; Open surgery

胸腰椎骨折是一種严重影响人类身心健康的脊柱外科疾病，且其中50%为不稳定骨折，需行手术恢复脊柱稳定及功能[1]。其治疗原则是通过固定最大程度重建损失部位的稳固性，矫正伤椎高度、减压解除神经的损伤，保留神经功能。而椎弓根螺钉系统经过多年临床应用，在疗效上得到肯定。传统后路开放术式为暴露术野需广泛切开组织、持续牵引，造成椎旁肌的严重破坏，易形成皮肤坏死、椎旁肌萎缩、术后腰部僵直疼痛等问题[2]。……