發(fā)布時(shí)間：2018-03-13 07:05

  本文選題：胸腰椎骨折脫位　切入點(diǎn)：經(jīng)肌間隙入路　出處：《遵義醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:比較后路經(jīng)肌間隙椎弓根螺釘內(nèi)固定術(shù)與傳統(tǒng)開放椎弓根螺釘內(nèi)固定術(shù)治療胸腰椎骨折脫位型損傷的臨床療效。方法:選取2013年01月~2016年01月手術(shù)治療胸腰椎骨折脫位型損傷患者40例進(jìn)行回顧性分析(男,25;女,15),年齡在18~60歲。由于手術(shù)入路的不同,分為肌間隙入路組(Mis-open組)及傳統(tǒng)開放入路組(Open組),其中Mis-open組行后路經(jīng)肌間隙椎管減壓、復(fù)位、植骨融合、椎弓根螺釘內(nèi)固定術(shù)20例(男,12;女,8),年齡在21~60歲。術(shù)前美國脊髓損傷協(xié)會(huì)(American Spinal Injury Association,ASIA)神經(jīng)功能分級(jí):A級(jí)14例,B級(jí)5例,C級(jí)1例。Open組行傳統(tǒng)開放椎管減壓、復(fù)位、植骨融合、椎弓根螺釘內(nèi)固定術(shù)20例(男,13;女,7),年齡在18~58歲。美國脊髓損傷分級(jí)(American Spinal Injury Association,ASIA)神經(jīng)功能分級(jí):A級(jí)14例、B級(jí)2例、C級(jí)3例、D級(jí)1例。1.分別采用計(jì)時(shí)器、負(fù)壓吸引裝置、負(fù)壓引流球分別記錄兩組手術(shù)時(shí)間、中出血量、術(shù)后引流量,評(píng)估兩組圍手術(shù)期療效。2.采用視覺模擬評(píng)分(Visual Analogue Score,VAS)評(píng)估兩組術(shù)后切口疼痛情況。3.采用游標(biāo)卡尺在傷椎電子計(jì)算機(jī)斷層掃描(Computed Tomography,CT)橫斷位上測(cè)量椎管矢狀徑,計(jì)算兩組術(shù)前及術(shù)后的椎管通暢率,評(píng)估兩組椎管減壓情況。4.分別采用游標(biāo)卡尺、量角器在傷椎側(cè)位平片上分別測(cè)量術(shù)前及術(shù)后的傷椎前緣高度的百分比、Cobb角,評(píng)估兩組后凸矯正情況。5.采用ASIA分級(jí)標(biāo)準(zhǔn)評(píng)估兩組患者的神經(jīng)功能情況。40例患者隨訪了9~33個(gè)月,其中Mis-open組隨訪(19.3±5.6)個(gè)月,Open組隨訪(22.5±4.9)個(gè)月,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)果:1.Mis-open組的手術(shù)時(shí)間(240.5±38.3)min、術(shù)中出血量(525.0±168.2)ml、術(shù)后引流量(190.1±78.9)ml、術(shù)后24小時(shí)及末次隨訪VAS評(píng)分分別為(6.4±1.0、1.6±0.5)。末次隨訪椎管通暢率、傷椎前緣高度的百分比、Cobb角分別為(85.3±3.7)%、(85.5±2.7)%、(4.7±1.2)°。Mis-open組末次隨訪ASIA分級(jí)情況:7例A級(jí)、5例B級(jí)、6例C級(jí)、1例D級(jí)、1例E級(jí)。Open組的手術(shù)時(shí)間(258.5±43.7)min、術(shù)中出血量(770.0±269.2)ml、術(shù)后引流量(281.7±122.3)ml、術(shù)后24小時(shí)及末次隨訪VAS評(píng)分為(7.8±0.7、2.2±0.4),末次隨訪椎管通暢率、傷椎前緣高度的百分比、Cobb角分別為(85.8±1.8)%、(88.8±1.3)%、(5.3±1.5)°。Open組末次隨訪ASIA分級(jí)情況:6例A級(jí)、6例B級(jí)、5例C級(jí)、2例D級(jí)、1例E級(jí)。2.兩組間在手術(shù)時(shí)間,術(shù)前、末次隨訪椎管通暢率、傷椎前緣高度的百分比、Cobb角指標(biāo)比較無統(tǒng)計(jì)學(xué)差異(P0.05)。3.兩組間在術(shù)中出血量、術(shù)后引流量、術(shù)后VAS評(píng)分上Mis-open組優(yōu)于Open組,有統(tǒng)計(jì)學(xué)差異(P0.05)。4.同組內(nèi)在末次隨訪時(shí)的VAS評(píng)分、椎管通暢率、傷椎前緣高度的百分比、Cobb角上比較術(shù)前,有統(tǒng)計(jì)學(xué)差異(P0.05)。5.兩組間術(shù)前神經(jīng)功能比較,差異沒有統(tǒng)計(jì)學(xué)意義(Z=-0.42,P=0.68)。兩組間末次隨訪神經(jīng)功能比較,差異沒有統(tǒng)計(jì)學(xué)意義(Z=-1.51,P=0.13)。Mis-open組組內(nèi)術(shù)前和末次隨訪神經(jīng)功能比較,差異有統(tǒng)計(jì)學(xué)意義(Z=-2.89,P=0.004);Open組組內(nèi)術(shù)前和末次隨訪神經(jīng)功能比較,差異有統(tǒng)計(jì)學(xué)意義(Z=-2.63,P=0.009)。結(jié)論:后路經(jīng)肌間隙減壓、復(fù)位、植骨融合、椎弓根螺釘內(nèi)固定術(shù)治療胸腰椎骨折脫位型損傷不僅能夠有效恢復(fù)傷椎椎管通暢率及前緣高度的同時(shí),還能減少手術(shù)創(chuàng)傷、術(shù)中出血、術(shù)后引流量、術(shù)后切口疼痛,是一種值得借鑒及推廣的手術(shù)方式。
[Abstract]:Objective: To compare the clinical efficacy of the treatment of posterior dislocation injury of thoracolumbar fracture intermuscular pedicle screw fixation with traditional open pedicle screw fixation. Methods: from 2013 01 months ~2016 years 01 months of surgery in the treatment of patients with thoracolumbar fracture and dislocation injury in 40 cases were analyzed retrospectively (male, 25; female, 15), at the age of 18~60. Because of the different surgical approaches, divided into paraspinal approach group (group Mis-open) and traditional open approach group (Open group), Mis-open group underwent posterior intermuscular decompression, reduction, bone fusion and pedicle screw fixation in 20 cases (male, 12; female, 8), at the age of 21~60. Preoperative American Spinal Injury Association (American Spinal Injury Association, ASIA) nerve function grading: Grade A in 14 cases, 5 cases of grade B, grade C in 1 cases of.Open group underwent conventional open reduction, decompression, interbody fusion and pedicle screw fixation in 20 cases (male, 13; female , 7), at the age of 18~58. The classification of spinal cord injury (American Spinal Injury Association, ASIA) nerve function grading: Grade A in 14 cases, 2 cases of grade B, C grade 3 cases, D 1 cases of grade.1. respectively using the timer, negative pressure suction device, negative pressure drainage ball were recorded in the two groups in operation time, bleeding the amount, postoperative drainage, the perioperative effect of two groups was evaluated by visual analogue scale (.2. Visual Analogue Score, VAS) assessment of two groups of postoperative incision pain in vertebral.3. using vernier caliper computedtomography (Computed Tomography, CT) on the measurement of axial sagittal diameter of spinal canal, the two groups were calculated before and after the operation of the canal patency rate of two groups was evaluated respectively by.4. decompression in vertebral protractor vernier caliper, lateral radiographs were measured on preoperative and postoperative anterior vertebral height percentage, Cobb angle, kyphosis correction in two groups were assessed by.5. ASIA 綰ф爣鍑嗚瘎浼頒袱緇勬?zhèn)ｈ�呯殑紲炵粡鍔熻兘鎯呭喌.40渚嬫?zhèn)ｈ�呴殢璁夸簡(jiǎn)9~33涓湀,鍏朵腑Mis-open緇勯殢璁，

本文編號(hào)：1605298