【摘要】：目的:對比經(jīng)肌間隙入路單運(yùn)動單元椎弓根釘內(nèi)固定與經(jīng)傷椎雙運(yùn)動單元椎弓根釘內(nèi)固定治療A1型胸腰椎骨折(AO分型A1型)的臨床療效。方法:回顧性分析2010年1月至2015年1月采用經(jīng)椎旁肌間隙入路單運(yùn)動單元和經(jīng)傷椎雙運(yùn)動單元椎弓根釘固定治療胸腰段單一椎體骨折(AO分型A1型)80例患者的臨床資料,其中男性患者46例,女性患者34例,年齡在22歲至60歲之間,平均年齡38.8歲。按運(yùn)動單元固定不同分為單運(yùn)動單元固定組36例和雙運(yùn)動單元固定組44例,所有患者均采取手術(shù)治療且手術(shù)入路相同,均為經(jīng)后路椎旁肌間隙入路。記錄并測量兩組患者的手術(shù)時(shí)間、出血量,術(shù)前、術(shù)后3天及術(shù)后1年傷椎其上下相鄰正常椎體的前緣高度以及矢狀面Cobb角。對統(tǒng)計(jì)數(shù)據(jù)運(yùn)用SPSS17.0軟件進(jìn)行統(tǒng)計(jì)學(xué)處理,分析比較兩種手術(shù)方式的差異。結(jié)果:80例A1型胸腰椎骨折手術(shù)治療均取得成功,術(shù)后無嚴(yán)重并發(fā)癥發(fā)生。全部病例在術(shù)后均進(jìn)行隨訪。單運(yùn)動單元固定組36例,手術(shù)時(shí)間為(75.34±10.17)min,手術(shù)出血量為(206.23±25.43)ml,雙運(yùn)動單元固定組44例,手術(shù)時(shí)間為(115.57±13.53)min,手術(shù)出血量為(230.32±32.34)ml,雙運(yùn)動單元組的手術(shù)時(shí)間及手術(shù)出血量均高于單運(yùn)動單元固定組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05),術(shù)前單運(yùn)動單元固定組椎體壓縮率為44.56%±4.5%,雙運(yùn)動單元固定組椎體壓縮率為45.53±8.2%,Cobb角分別為24.5°±4.1°、25.7°±5.6°,術(shù)后第3天兩組椎體的壓縮率分別為9.33%±5.3%、8.69%±5.4%,cobb角分別為9.3°±1.5°、8.9°±3.2°,差異無統(tǒng)計(jì)學(xué)意義(P0.05),一年后隨訪時(shí)單、雙運(yùn)動單元組椎體壓縮率分別為11.83%±4.1%、10.13%±2.6%,Cobb角分別為10.1°±1.5°、9.9°±3.1°,差異無統(tǒng)計(jì)學(xué)意義;與術(shù)后第三天統(tǒng)計(jì)數(shù)據(jù)相比,差異仍無統(tǒng)計(jì)學(xué)意義。結(jié)論:對于A1型胸腰椎骨折而言,Wiltse肌間隙入路單、雙運(yùn)動單元經(jīng)傷椎椎弓根釘內(nèi)固定均可有效緩解疼痛、恢復(fù)傷椎椎體前緣高度及Cobb角,但單運(yùn)動單元固定具有手術(shù)操作簡單、手術(shù)時(shí)間短、出血量少等優(yōu)點(diǎn),更重要的是增加椎體活動度并減少對鄰近椎體的影響,有較好的推廣應(yīng)用價(jià)值。
[Abstract]:Aim: to compare the clinical effects of single motor unit pedicle screw fixation via muscle space approach and double motor unit pedicle screw fixation through injured vertebrae in the treatment of type A1 thoracolumbar fracture (AO type A1). Methods: from January 2010 to January 2015, 80 patients with thoracolumbar single vertebral fracture (AO type A1) were treated with single motor unit through paravertebral intermuscular space and pedicle screw fixation with double motor unit through injured vertebrae, and the clinical data of 80 patients with thoracolumbar fracture (type A1) were analyzed retrospectively. There were 46 males and 34 females, aged from 22 to 60, with an average age of 38.8 years. According to the different fixation of motor unit, 36 cases of single motor unit fixation group and 44 cases of double motor unit fixation group were divided into two groups. All the patients were treated by operation and the approach was the same, all of them were through posterior paravertebral intermuscular space approach. The operation time, bleeding volume, anterior height and sagittal Cobb angle of the upper and lower adjacent normal vertebrae of the injured vertebrae were recorded and measured before, 3 days after operation and 1 year after operation. The statistical data were processed by SPSS17.0 software, and the differences between the two surgical methods were analyzed and compared. Results: all 80 cases of A 1 type thoracolumbar fracture were successfully treated, and no serious complications occurred after operation. All cases were followed up after operation. The operation time was (75.34 鹵10.17) min, the bleeding volume was (206.23 鹵25.43) ml, in the double motor unit fixation group, and the operative time was (115.57 鹵13.53) min, in the double motor unit fixation group (n = 44). The operative bleeding volume was (230.32 鹵32.34) ml, double motor unit group's operation time and operation bleeding volume were higher than that of single motor unit fixation group, the difference was statistically significant (P0.05). The vertebral compression rate was 44.56% 鹵4.5% in the single motor unit fixation group, 45.53 鹵8.2% in the double motor unit fixation group, and 24.5 擄鹵4.1 擄and 25.7 擄鹵5.6 擄in the double motor unit fixation group, respectively, and the Cobb angle was 24.5 擄鹵4.1 擄and 25.7 擄鹵5.6 擄, respectively. The compression rate was 9.33% 鹵5.3%, 8.69% 鹵5.4%, and the Cobb angle was 9.3 擄鹵1.5 擄and 8.9 擄鹵3.2 擄, respectively. There was no significant difference between the two groups on the 3rd day after operation (P0.05). The vertebral compression rates were 11.83% 鹵4.1%, 10.13% 鹵2.6%, and Cobb angles were 10.1 擄鹵1.5 擄and 9.9 擄鹵3.1 擄in the dual motor unit group, respectively. There was no significant difference between the two groups (P < 0.05). Compared with the statistical data on the third day after operation, the difference was still not statistically significant. Conclusion: for type A1 thoracolumbar fractures, the single approach of Wiltse muscle space and internal fixation of double motor units through pedicle screw can effectively relieve pain and restore the height of anterior edge and Cobb angle of injured vertebrae. However, single motor unit fixation has the advantages of simple operation, short operation time and less bleeding. It is more important to increase the degree of vertebral body movement and reduce the influence on the adjacent vertebral body, which has a good value of popularization and application.
【學(xué)位授予單位】：蚌埠醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R687.3

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本文編號：2435558