發(fā)布時間：2018-03-09 09:36

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

【摘要】：目的:對比直視下微創(chuàng)與經(jīng)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(xué)附屬醫(yī)院脊柱外科收治無神經(jīng)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(biāo)準(zhǔn):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(zhì)疏松、腫瘤等其他原因?qū)е碌牟±硇怨钦?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(nèi)固定術(shù),對照組采用經(jīng)皮微創(chuàng)椎弓根螺釘內(nèi)固定術(shù),分別記錄兩組患者的切口長度、手術(shù)時間、術(shù)中出血量、術(shù)中透視次數(shù)、住院時間、切口愈合狀況、耗材費用,術(shù)前及術(shù)后3個月傷椎前緣高度比例、術(shù)后48h VAS評分?jǐn)?shù)據(jù)資料進行臨床對比研究。結(jié)果:實驗組與對照組患者通過術(shù)后3個月定期復(fù)查拍攝胸腰段X線的方式進行術(shù)后隨訪。直視下微創(chuàng)組(實驗組)切口長度10.42±0.63cm、手術(shù)時間87.20±4.65min、術(shù)中透視次數(shù)2.80±0.41次;經(jīng)皮微創(chuàng)組(對照組)切口長度12.18±0.32cm、手術(shù)時間108.08±6.77min、術(shù)中透視次數(shù)13.76±1.92次,差異均存在統(tǒng)計學(xué)意義(p0.05),而實驗組在術(shù)前及術(shù)后3個月傷椎前緣高度比例、術(shù)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(xué)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(jié)論:直視下微創(chuàng)與經(jīng)皮微創(chuàng)雖屬不同微創(chuàng)術(shù)式,但在治療無神經(jīng)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(shù)更易于術(shù)者掌握,且更為經(jīng)濟、避免過多的醫(yī)源性輻射,具有經(jīng)皮微創(chuàng)術(shù)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(xué)位授予單位】：青海大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R687.3

【參考文獻】

相關(guān)期刊論文 前9條

1 聶鋒鋒;張英華;黃壽國;鞠亮;陳波;;經(jīng)皮微創(chuàng)椎弓根螺釘內(nèi)固定與開放手術(shù)治療胸腰椎骨折:Cobb’s角與椎體前緣高度恢復(fù)的比較[J];中國組織工程研究;2014年44期

2 段麗群;張文志;尚希福;許翔;胡業(yè)豐;;微創(chuàng)經(jīng)皮椎弓根螺釘內(nèi)固定術(shù)治療胸腰椎骨折的臨床療效分析[J];頸腰痛雜志;2012年05期

3 張文志;尚希福;段麗群;許翔;胡業(yè)豐;賀瑞;李旭;;微創(chuàng)經(jīng)皮與傳統(tǒng)開放椎弓根螺釘內(nèi)固定治療胸腰椎骨折的臨床對比研究[J];中國骨與關(guān)節(jié)外科;2012年02期

4 周成文;牟永山;馬惠章;李秀海;馬海龍;馬紅剛;;微創(chuàng)經(jīng)皮椎弓根釘固定治療胸腰椎壓縮性骨折[J];實用骨科雜志;2011年11期

5 宋慶偉;紀(jì)樹青;岳志豐;;椎弓根釘棒系統(tǒng)固定治療胸腰椎骨折療效觀察[J];山東醫(yī)藥;2011年28期

6 胡勇;李開凡;徐榮明;阮永平;馬維虎;;經(jīng)皮椎弓根技術(shù)治療胸腰椎骨折的臨床探討[J];中國骨傷;2006年10期

7 黃其杉;彭茂秀;林焱;毛方敏;倪文飛;王向陽;池永龍;徐華梓;;經(jīng)皮椎弓根螺釘固定治療胸腰椎骨折[J];中華骨科雜志;2005年12期

8 楊雷,李家順,賈連順,池永龍,徐華梓,毛方敏,黃其杉,王向陽;經(jīng)皮植入椎弓根螺釘?shù)腃T掃描釘?shù)婪治龊团R床評價[J];中國矯形外科雜志;2003年10期

9 王亦璁;骨折治療的微創(chuàng)術(shù)式[J];中華骨科雜志;2002年03期

，

本文編號：1587971