本文選題：微創(chuàng)　切入點：胸腰段　出處：《青海大學》2016年碩士論文　論文類型：學位論文

【摘要】：目的:對比直視下微創(chuàng)與經皮微創(chuàng)治療胸腰段椎體骨折(T11-L2)的臨床療效。方法:選擇2014年11月至2015年06月青海大學附屬醫(yī)院脊柱外科收治無神經系統(tǒng)損傷的胸腰段椎體骨折50例作為研究對象,隨機分為實驗組與對照組。研究對象的入選標準:1受傷機制:通常由車禍、高處墜落傷等外傷史造成,排除骨質疏松、腫瘤等其他原因導致的病理性骨折;2年齡界限:18歲~55歲;3臨床癥狀:不伴四肢感覺活動障礙,會陰部感覺障礙;4輔助檢查:胸腰段X-Ray、胸腰段CT三維重建及MRI可見T11-L2單節(jié)段椎體骨折,診斷明確。實驗組采用直視下微創(chuàng)椎弓根螺釘內固定術,對照組采用經皮微創(chuàng)椎弓根螺釘內固定術,分別記錄兩組患者的切口長度、手術時間、術中出血量、術中透視次數(shù)、住院時間、切口愈合狀況、耗材費用,術前及術后3個月傷椎前緣高度比例、術后48h VAS評分數(shù)據(jù)資料進行臨床對比研究。結果:實驗組與對照組患者通過術后3個月定期復查拍攝胸腰段X線的方式進行術后隨訪。直視下微創(chuàng)組(實驗組)切口長度10.42±0.63cm、手術時間87.20±4.65min、術中透視次數(shù)2.80±0.41次;經皮微創(chuàng)組(對照組)切口長度12.18±0.32cm、手術時間108.08±6.77min、術中透視次數(shù)13.76±1.92次,差異均存在統(tǒng)計學意義(p0.05),而實驗組在術前及術后3個月傷椎前緣高度比例、術后48h VAS評分的數(shù)據(jù)與對照組比較,差異不存在統(tǒng)計學意義(p0.05)。實驗組的耗材費用固定為28243.6元,對照組的耗材費用固定為30143.6元,在耗材的費用上實驗組比對照組低;實驗組與對照組患者的切口愈合狀況均為I/甲即完全愈合,說明愈合效果一致。結論:直視下微創(chuàng)與經皮微創(chuàng)雖屬不同微創(chuàng)術式,但在治療無神經損傷性胸腰段椎體骨折(T11-L2)具有相同臨床療效,而直視下微創(chuàng)技術更易于術者掌握,且更為經濟、避免過多的醫(yī)源性輻射,具有經皮微創(chuàng)術式不可比擬的優(yōu)點。
[Abstract]:Objective: to compare the clinical effects of minimally invasive and percutaneous minimally invasive treatment of thoracolumbar vertebral fractures under direct vision. Methods: from November 2014 to June 2015, the thoracolumbar segment with no nervous system injury was treated in the Department of Spinal surgery, Qinghai University affiliated Hospital. Fifty cases of vertebral body fracture were studied. The subjects were randomly divided into experimental group and control group. The study subjects were selected as the injury mechanism of 1: 1: usually caused by a history of injuries such as car accidents, falls from high places, and so on, excluding osteoporosis. Pathological fractures caused by tumors and other causes have a 2% age limit of 20 to 55 years old and clinical symptoms: no sensory dysfunction in the extremities, Accessory examination of perineal sensory disorders: thoracolumbar X-Ray, three-dimensional CT reconstruction of thoracolumbar segment and T11-L2 single level vertebral body fracture by MRI, the diagnosis was clear. The experimental group was treated with minimally invasive pedicle screw fixation under direct vision. The patients in the control group were treated with percutaneous minimally invasive pedicle screw fixation. The incision length, operation time, intraoperative blood loss, fluoroscopy times, hospital stay time, wound healing status and consumable cost were recorded respectively in the two groups. The ratio of anterior height of injured vertebrae before operation and 3 months after operation, Results: the patients in the experimental group and the control group were followed up by taking chest and lumbar X-ray regularly 3 months after operation. The minimally invasive group (experimental group) was followed up under direct vision (experimental group). The length of incision was 10.42 鹵0.63 cm, the operative time was 87.20 鹵4.65 min, the times of fluoroscopy was 2.80 鹵0.41; In the percutaneous minimally invasive group (control group), the incision length was 12.18 鹵0.32 cm, the operative time was 108.08 鹵6.77 min, and the number of fluoroscopy was 13.76 鹵1.92 times. The difference was statistically significant (P 0.05). There was no significant difference between the data of VAS score 48 hours after operation and that of the control group (P 0.05). The cost of consumables was fixed at 28243.6 yuan in the experimental group and 30143.6 yuan in the control group. The expense of the experimental group was lower than that of the control group. The wound healing status of the patients in the experimental group and the control group was I / A, which indicated that the healing effect was the same. Conclusion: minimally invasive and transdermal minimally invasive under direct vision are different minimally invasive procedures. But in the treatment of thoracolumbar vertebral fracture without nerve injury, T11-L2) has the same clinical effect, and the minimally invasive technique under direct vision is easier for the operator to master, more economical, avoid excessive iatrogenic radiation, and has the advantage that the percutaneous minimally invasive operation is incomparable to that of the percutaneous minimally invasive operation.
【學位授予單位】：青海大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R687.3

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