刘昌余

【摘要】 目的：探讨脊柱骨折患者分别实施后路经皮置钉椎弓根钉内固定手术及开放置钉椎弓根钉内固定手术治疗的临床效果。方法：回顾性选取2021年1月—2022年12月咸宁市第一人民医院收治的80例脊柱骨折患者，依据不同的手术方式将80例患者分为两组，实施开放置钉椎弓根钉内固定手术治疗的40例患者命名为对照组，实施后路经皮置钉椎弓根钉内固定手术治疗的40例患者命名为观察组，对比两组的围手术期指标、术前术后的应激反应、炎症反应、疼痛程度、伤椎恢复情况。结果：观察组术中出血量、手术时间、术后下床时间、住院时间均优于对照组，差异均有统计学意义（P<0.05）；术后3 d血清肌酸激酶（CK）与血清皮质醇（Cor）比较，观察组均低于对照组，差异均有统计学意义（P<0.05）；术后3 d肿瘤坏死因子-α（TNF-α）和C反应蛋白（CRP）比较，观察组均低于对照组，差异均有统计学意义（P<0.05）；观察组术后1周的视觉模拟评分法（VAS）评分比对照组低，差异有统计学意义（P<0.05）；两组术后1周的Cobb角与伤椎前缘压缩率均比术前低，差异均有统计学意义（P<0.05），但观察组的Cobb角、伤椎前缘压缩率与对照组相比，差异均无统计学意义（P>0.05）。结论：后路经皮置钉椎弓根钉内固定手术及开放置钉椎弓根钉内固定手术均能有效促进脊柱骨折患者的伤椎恢复，但后路经皮置钉椎弓根钉内固定手术术后恢复时间短、应激反应和炎症反应轻、术后疼痛感轻。

【关键词】 脊柱骨折 后路经皮置钉 开放置钉 椎弓根钉内固定手术

Clinical Effect of Posterior Percutaneous and Open Pedicle Screw Internal Fixation for Spinal Fracture/LIU Changyu. //Medical Innovation of China， 2024， 21（13）： 0-051

[Abstract] Objective： To investigate the clinical effect of posterior percutaneous pedicle screw internal fixation and open pedicle screw internal fixation in patients with spinal fracture. Method： A retrospective study of 80 patients with spinal fracture admitted to the First People's Hospital of Xianning City from January 2021 to December 2022 was conducted. The 80 patients were divided into two groups according to different surgical methods， and 40 patients who underwent open pedicle screw internal fixation were named as the control group. Forty patients who underwent posterior percutaneous pedicle screw internal fixation were named observation group， and the perioperative indexes， stress response， inflammation response， pain degree and conical recovery of the two groups were compared. Result： The intraoperative blood loss， operation time， postoperative getting out of bed time and hospital stay time in the observation group were all better than those in the control group， the differences were statistically significant （P<0.05）. Three days after surgery， the serum creatine kinase （CK） and serum cortisol （Cor） levels in the observation group were lower than those in the control group， the differences were statistically significant （P<0.05）. Three days after surgery， the tumor necrosis factor-α （TNF-α） and C reactive protein （CRP） in the observation group were lower than those in the control group， the differences were statistically significant （P<0.05）. The visual analogue scale （VAS） of the observation group was lower than that of the control group at 1 week after operation， the difference was statistically significant （P<0.05）. The Cobb angle and compression rate of the anterior edge of the injured cone in the two groups at 1 week after operation were lower than those before operation， the differences were statistically significant （P<0.05）， but there were no significant differences in Cobb angle and compression rate of the anterior edge of the injured cone between the observation group and the control group （P>0.05）. Conclusion： Both posterior percutaneous pedicle screw internal fixation and open pedicle screw internal fixation can effectively promote conical recovery in patients with spinal fractures， but posterior percutaneous pedicle fixation has short postoperative recovery time， light stress and inflammation reaction， and light postoperative pain.

[Key words] Spinal fracture Posterior percutaneous nail placement Open placement of nail Pedicle screw internal fixation surgery

First-author's address： Department of Orthopedics， the First People's Hospital of Xianning City， Xianning 437000， China

doi：10.3969/j.issn.1674-4985.2024.13.011

脊柱骨折是临床上较为常见的一种骨科疾病，以腰部活动受限、下腰痛为主要症状，若患者未能及时得到有效治疗，不仅会加重其疼痛症状，引发功能障碍，还会造成脊髓损伤，增加神经功能障碍等并发症的发生风险，进而危及其生命安全[1]。椎弓根钉内固定手术是临床治疗脊柱骨折的常见术式之一，可以有效促进骨折部位解剖结构的恢复，改善患者的脊柱功能，提高其日常活动能力，但在实际的手术过程中，不同置钉方式对手术效果和患者的术后恢复效果的影响均存在一定的差异性[2-3]。……