熊怀风　　丁超　　梁甜　　王敏　　刘庆波　　李传望　　詹义兵

[摘要] 目的 探讨在微创通道下减压结合经皮椎弓根螺钉复位内固定治疗伴有神经根损伤的胸腰椎骨折疗效。方法 选取2019年6月至2020年6月于本院就诊的胸腰椎骨折伴神经根损伤患者60例，按照单双日分成A组与B组，每组各30例。A组予以传统开放椎弓根螺钉复位内固定治疗，B组在微创通道下减压结合经皮椎弓根螺钉复位内固定治疗。并比较治疗前后伤椎Cobb角，伤椎椎体前缘高度比值变化，术后疼痛程度及相关手术指标。结果 术后两组患者各时间节点伤椎Cobb角，伤椎椎体前缘高度比值比较，差异无统计学意义（P>0.05）。术后24 h疼痛程度评分比较，A组高于B组，差异有统计学意义（P<0.05）。A组手术时间、术中出血、切口长度及术后引流量为（147.61±10.36）min，（344.46±40.56）mL，（12.34±1.79）cm，（224.10±9.89）mL;B组分别为（121.23±7.78）min，（91.28±5.98）mL，（7.71±1.28）cm，（54.56±6.78）mL;B组均低于A组，差异有统计学意义（P<0.05）。 结论 对胸腰椎骨折伴神经根损伤患者在微创通道下减压结合经皮椎弓根螺钉复位内固定治疗，可取得与传统开放手术相同的疗效，但其创伤性更低，安全性更高，有助于减轻患者术后疼痛，并加快患者康复，具有推广应用价值。

[关键词] 微创通道;减压;经皮椎弓根螺钉复位内固定;神经根损伤;胸腰椎骨折;疼痛度

[中图分类号] R687.3          [文獻标识码] B          [文章编号] 1673-9701（2021）14-0092-03

Treatment of thoracolumbar fracture with nerve root injury by minimally invasive decompression combined with percutaneous pedicle screw reduction and internal fixation

XIONG Huaifeng   DING Chao   LIANG Tian   WANG Min   LIU Qingbo   LI Chuanwang   ZHAN Yibing

The Second Department of Osteology， Jingzhou Third People′s Hospital in Hubei Province， Jingzhou   434000， China

[Abstract] Objective To explore the therapeutic effect of minimally invasive decompression combined with percutaneous pedicle screw reduction and internal fixation on thoracolumbar fractures with nerve root injury. Methods A total of 60 patients with thoracolumbar fracture and nerve root injury in our hospital from June 2019 to June 2020 were divided into group A and group B， with 30 cases in each group. Group A was treated with traditional open pedicle screw reduction and internal fixation， while group B was treated with minimally invasive channel decompression combined with percutaneous pedicle screw reduction and internal fixation. The Cobb angle of the injured vertebra， the changes of the ratio of the anterior height of the injured vertebral body， the degree of postoperative pain and related surgical indexes before and after treatment were compared. Results The Cobb angle of the injured vertebra and the ratio of the anterior edge height of the injured vertebral body in the two groups had no comparative value at each time node after operation（P>0.05）. The pain degree score was higher in group A than that of group B on the 24 h after operation， and the comparison was statistically significant（P<0.05）. The operation time，intraoperative bleeding， incision length and postoperative drainage volume were （147.61±10.36） min， （344.46±40.56） mL，（12.34 ±1.79） cm and （224.10±9.89） mL in group A， respectively， and （121.23±7.78） min， （91.28±5.98）mL， （7.71±1.28）cm， （54.56±6.78）mL in group B， respectively Group B WCLS lower than Group A， the differences between the two groups were statistically significant（P<0.05）. Conclusion Minimally invasive decompression combined with percutaneous pedicle screw reduction and internal fixation can achieve the same curative effect as traditional open surgery for thoracolumbar fractures with nerve root injury， with less trauma and higher safety.It is helpful to relieve postoperative pain and accelerate recovery of patients，with popularization and application value.

[Key words] Minimally invasive channel; Decompression; Percutaneous pedicle screw reduction and internal fixation; Nerve root injury; Thoracolumbar fracture; Degree of pain

临床骨科常见骨折疾病之一为胸腰椎骨折伴神经根损伤，主要以车祸伤为主[1]。并且该种疾病近些年来，呈逐渐上升趋势。针对此种疾病主要以外科手术治疗为主，但是以往的传统手术治疗效果欠佳，而随着医疗技术的发展，微创手术逐渐广泛应用于临床，其具有对患者机体产生的损伤小，且手术室时间短，老年患者易耐受，术后康复速度较快，治疗效果显著等优点[2]。现阶段临床中，应用较多且疗效较好的微创手术治疗方式，主要包括经皮椎弓根螺钉复位内固定治疗和微创通道下减压。本研究纳入研究胸腰椎骨折伴神经根损伤患者60例，并于2019年6月至2020年6月开展医学研究，着重分析在微创通道下减压结合经皮椎弓根螺钉复位内固定术疗效及可行性，现报道如下。