本文選題：胸椎 + 腰椎��； 參考：《中國組織工程研究》2017年27期

【摘要】：背景:傳統(tǒng)開放手術(shù)方式治療脊柱胸腰段骨折會(huì)對患者造成較大創(chuàng)傷,有加速脊柱局部退變可能。新的微創(chuàng)手術(shù)方式減小了患者創(chuàng)傷,患者能得到更好的恢復(fù),對傳統(tǒng)手術(shù)提出挑戰(zhàn)。目的:探討經(jīng)皮微創(chuàng)單向固定實(shí)心椎弓根釘植入內(nèi)固定治療胸腰椎骨折的操作要點(diǎn)和注意事項(xiàng)。方法:選擇行經(jīng)皮微創(chuàng)單向?qū)嵭淖倒攦?nèi)固定治療單一胸腰椎骨折不伴有脊髓損傷患者27例,其中24例患者骨折椎體高度恢復(fù)良好,另3例通過適度加大椎弓根釘鏈接棒弧度輔助抗扭矩套筒套于椎弓根釘尾冒以后柱為支點(diǎn)張開脊柱前柱得到良好復(fù)位。觀察手術(shù)時(shí)間、術(shù)中出血量,內(nèi)固定前1d軸向翻身目測類比評分、內(nèi)固定后第1天術(shù)區(qū)目測類比評分、內(nèi)固定后第3天術(shù)區(qū)及軸向翻身目測類比評分。結(jié)果與結(jié)論:①27例患者108個(gè)椎體均在靶點(diǎn)細(xì)針參照法引導(dǎo)下經(jīng)椎弓根途徑穿刺置釘,穿刺順利,98個(gè)椎體一次性穿刺成功,余10個(gè)椎體二次調(diào)整進(jìn)針點(diǎn)穿刺置釘成功;②內(nèi)固定后第3天軸向翻身目測類比評分顯著低于內(nèi)固定前1天(P0.001);內(nèi)固定后第3天術(shù)區(qū)目測類比評分顯著低于內(nèi)固定后第1天(P0.001);③手術(shù)時(shí)間及經(jīng)皮單向?qū)嵭淖倒攦?nèi)固定手術(shù)時(shí)間平均(109±18)min;術(shù)中出血平均(60±16)mL;④術(shù)后無神經(jīng)根損害并發(fā)癥發(fā)生;(5)結(jié)果說明,經(jīng)皮單向?qū)嵭淖倒踩牍潭ㄖ委煵话橛屑顾钃p傷及椎間盤嚴(yán)重受損的單一胸腰椎骨折的微創(chuàng)手術(shù)方式有效且安全;靶點(diǎn)細(xì)針參照引導(dǎo)穿刺技術(shù)作為簡單易行的方法能夠顯著降低經(jīng)椎弓根途徑的穿刺難度,具有極高的一次性穿刺成功率。
[Abstract]:Background: traditional open surgery for thoracolumbar spine fracture will cause greater trauma to patients, which may accelerate the local degeneration of spine. The new minimally invasive surgery reduces the trauma of patients and improves the recovery of patients. Objective: to explore the operative points and cautions for the treatment of thoracolumbar fractures by percutaneous minimally invasive unilateral fixation with solid pedicle nail. Methods: Twenty-seven patients with single thoracolumbar fracture without spinal cord injury were treated with percutaneous minimally invasive solid pedicle screw fixation. In the other 3 cases, the anterior column of the spine was opened at the fulcrum point of the pedicle nail, and the anterior column of the spine was well reduced by appropriately increasing the pedicle screw link bar Radian assisted with the anti-torque sleeve set after the end of the pedicle nail. The time of operation, the amount of blood loss during operation, the visual analogue score of axial turn over at 1 day before internal fixation, the visual analogue score of operation area on the first day after internal fixation, and the visual analogue score of operation area and axial turn over on the 3rd day after internal fixation were observed. Results and conclusion 108 vertebrae of 127 patients were punctured by pedicle method under the guidance of target fine needle reference method. The puncture was successful, 98 vertebrae were punctured successfully, and the remaining 10 vertebrae were punctured successfully at the point of readjustment of the vertebral body. 2 the visual analogies of axial rotation on the 3rd day after internal fixation were significantly lower than those on the first day of internal fixation (P 0.001), and the visual analogue scores of operation area on the third day after internal fixation were significantly lower than those on the first day after internal fixation, and the time of operation and the percutaneous unilateral solid pedicle were significantly lower than those on the first day after internal fixation. The average operation time of root nail fixation was 109 鹵18min, and the average intraoperative bleeding was 60 鹵16m LL4. There was no complication of nerve root injury after operation. The minimally invasive procedure for the treatment of single thoracolumbar fractures without spinal cord injury and severe disc injury was effective and safe. As a simple and easy method, the target fine needle guided puncture technique can significantly reduce the difficulty of transpedicular puncture, and has a very high success rate of single puncture.
【作者單位】： 武漢市普仁醫(yī)院骨一科;
【分類號】：R687.3

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