【摘要】：目的:比較分析經傷椎置釘固定與跨傷椎固定在胸腰段骨折治療中的臨床療效。方法:回顧性分析2014年12月至2016年1月期間我院收治的62例胸腰段骨折患者的臨床資料,按內固定方式進行隨機分組,其中以27例經傷椎椎弓根固定作為實驗組,35例跨傷椎椎弓根固定作為對照組,對兩組患者性別、年齡、損傷節(jié)段、受傷原因等一般資料進行數(shù)據相關統(tǒng)計分析,差異無顯著性意義(P0.05),具有可比性。比較兩組患者手術時間、術中出血、術后輸血、住院天數(shù)及并發(fā)癥(切口感染、腰背部疼痛及內固定松動、斷裂等)的發(fā)生情況。兩組患者術后均隨訪1--2年,對并發(fā)癥的發(fā)生情況以及傷椎Cobb角、傷椎前緣高度比進行長期隨訪評價。結果:1兩組患者在手術及住院治療過程中,經傷椎組與跨傷椎組在手術時間、術中出血、術中輸血及住院時間方面,差異無顯著性意義(P0.05)。2 Cobb角和傷椎前緣高度方面,兩組在治療前差異未見顯著性意義,而在治療后及隨訪丟失方面,經傷椎組優(yōu)于跨傷椎組,差異具有統(tǒng)計學意義(P0.05)。3在疼痛視覺模擬評分方面,兩組組間比較,治療前、治療后差異均無顯著性意義,而經傷椎組在末次隨訪時要優(yōu)于跨傷椎組,差異有顯著性意義(P0.05)。4統(tǒng)計結果提示經長期隨訪兩種手術方式均能較為有效的復位固定傷椎,可較好的矯正損傷后脊柱畸形,緩解疼痛癥狀,改善、恢復患者的功能。與跨傷椎組相比,經傷椎組在恢復和維持脊柱的高度和曲度方面優(yōu)勢更加明顯,可更加有效的重建脊柱生理序列并維持其穩(wěn)定性,修復后腰背痛也可以得到有效控制。結論:與傳統(tǒng)跨傷椎固定相比,經傷椎椎弓根螺釘固定術能更好的重建脊柱穩(wěn)定,恢復及維持傷椎前緣高度和生理曲度,是治療胸腰段骨折一種安全有效的手術方法。
[Abstract]:Objective: to compare and analyze the clinical results of thoracolumbar fractures treated by transthoracic screw fixation and transthoracic spinal screw fixation. Methods: the clinical data of 62 patients with thoracolumbar fracture treated in our hospital from December 2014 to January 2016 were retrospectively analyzed. Among them, 27 cases of pedicle fixation of injured vertebrae were used as experimental group and 35 cases of transpedicular fixation as control group. The data of sex, age, injury segment and injury cause of patients in the two groups were statistically analyzed. There was no significant difference (P0.05), which was comparable. The time of operation, intraoperative bleeding, postoperative blood transfusion, hospital stay and complications (incision infection, back pain, loosening of internal fixation and breakage) were compared between the two groups. The patients in both groups were followed up for 1 to 2 years. The incidence of complications, the Cobb angle of injured vertebra and the ratio of anterior height of injured vertebrae were evaluated for a long time. Results there was no significant difference in operative time, intraoperative bleeding, intraoperative blood transfusion and hospital stay between the two groups during operation and hospitalization (P0.05). There was no significant difference in the angle of 2. 2 Cobb and the height of the anterior edge of the injured vertebra between the two groups (P0.05), and there was no significant difference between the two groups in terms of operation time, intraoperative bleeding, intraoperative blood transfusion and hospitalization time. There was no significant difference between the two groups before treatment, but in the loss after treatment and follow-up, the injured vertebra group was better than the cross-injured vertebra group. The difference was statistically significant (P0.05) in the visual analogue score of pain. There was no significant difference between the two groups after treatment, but the last follow-up was better in the injured vertebra group than in the cross-injured vertebra group, and the difference was significant (P0.05). The statistical results showed that the two kinds of surgical methods were effective in reduction and fixation of the injured vertebrae after long-term follow-up. It can correct spinal deformity after injury, relieve pain, improve and recover patients' function. Compared with the trans-injured vertebra group, the injured vertebra group has more obvious advantages in restoring and maintaining the height and curvature of the spine, which can effectively reconstruct the physiological sequence of the spine and maintain its stability, and can also be effectively controlled after the repair of low back pain. Conclusion: compared with the traditional transpedicular screw fixation, transpedicular screw fixation is a safe and effective method for the treatment of thoracolumbar fractures. It can reconstruct spinal stability, restore and maintain the anterior height and physiological curvature of the injured vertebrae, and is a safe and effective method for the treatment of thoracolumbar fractures.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.3

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