经皮椎弓根螺钉微创手术治疗胸腰椎骨折的临床效果研究【摘要】目的：探讨经皮椎弓根螺钉微创手术治疗胸腰椎骨折的临床效果。方法：选择2010年9月-2014年9月本院收治的42例损伤平面以下无神经功能损害、无须进行椎板减压的单纯胸腰椎骨折患者，按治疗方法不同分为微创组和对照组，每组21例。微创组于C臂X光机定位下确定需要固定的椎弓根进针部位，开4个均约1.5cm长的切口，骨折复位和固定均在4个小切口内完成，对照组采取常规8～10cm长的切口开放手术治疗。对所有患者进行12～48个月的随访。手术前后及随访时均摄正侧位X线片，测量患椎前后缘高度及后凸Cobb’s角。比较两组患者手术时间、术中出血量、骨折愈合时间，以ASIA神经损伤等级标准评定两组患者术后神经功能恢复情况。结果：两组患者术后均较术前恢复椎体高度及胸腰段局部后凸Cobb’s角，术后12个月，两组患者椎体高度及后凸Cobb’s角均有少许丢失，比较差异均有统计学意义（P<0.05）；末次随访时，两组患者均未见上述指标进一步丢失。微创组手术时间短于对照组，出血量少于对照组，骨折愈合时间短于对照组，治疗效果优于对照组，差异均有统计学意义（P<0.05）。结论：经皮椎弓根螺钉微创手术治疗胸腰椎骨折具有创伤小、出血少、住院时间短、骨折愈合快等优点，临床效果确切。【关键词】经皮；微创手术；胸腰椎骨折【Abstract】Objective：Tostudytheclinicaleffectofpercutaneouspediclescrewsofminimallyinvasivesurgeryinthetreatmentofthoracolumbarfractures.Method：Forty-twothoracolumbarfracturespatientswithoutneurologicdamageunderthedamageplaneortheneedofvertebrallaminadecompressionfromSeptember2010toSeptember2014admittedtoourhospitalwereselectedanddividedintotheminimallyinvasivegroupandthecontrolgroup，21patientsineachgroup.TheneedlepositionsofpedicleneedingfixedoftheminimallyinvasivegroupweredeterminedunderCarmX-raymachinepositioning，fourincisionsabout1.5cmlongwascutopen，inwhichthefracturereductionandfixationwerecompleted，whilethecontrolgroupwastakenregularabout8to10cmlongincisionopensurgery.Allpatientsreceivedfollow-upfor12-48months.ThefrontalandlateralX-rayfilmsofallpatientsweretakenbeforeandaftersurgeryandatthefollow-uptomeasuretheheightofvertebralbodyandtheCobb’sAngle.Thesurgerytime，bleedingvolumandfracturehealingtimewererecorded，therecoveryofnervefunctionwasjudgedbyASIAstandars.Result：PatientsoftwogroupspostoperativehadrestorationoflumbarvertebralheightandchestafterlocalconvexCobb’sAngle（P<0.05）.After12months，thevertebralbodyheightandtheprotrudingafterCobb’sAngleofpatientsintwogroupsallhadalittlelost（P<0.05）.Buttherewasnofurtherlossofindicatorsaboveintwogroupsatthelastfollow-up.Thesurgerytime，lengthofstayandfracturehealingtimeinminimallyinvasivegroupwereshorterthanthecontrolgroup，thebleedingvolumwaslessthanthecontrolgroup，thetreatmenteffectwasbetterthanthecontrolgroup，thedifferenceswerestatisticallysignificant（P<0.05）.Conclusion：Percutaneouspediclescrewminimallyinvasivesurgicaltreatmentofthoracolumbarfractureshassmalltrauma，lessbleeding，shorterlengthofstayandfastfracturehealing，whichshowsanexactlyclinicaleffect.【Keywords】Percutaneous；Minimallyinvasivesurgery；ThoracolumbarfracturesFirst-author’saddress：LonggangDistrictPeople’sHospitalofShenzhen，Shenzhen518000，Chinadoi：10.3969/j.issn.1674-4985.2016.12.027脊柱正常实施功能需要一个完整的组织结构[1]。以往胸腰椎骨折患者采用后路切开椎弓根螺钉内固定治疗已被多数学者认为是一种安全有效的方法[2]，但是传统的开放手术软组织剥离广泛，手术创伤大，出血多，术后长期腰背痛。近年来经皮椎弓根螺钉微创手术治疗胸腰椎骨折逐渐应用于胸腰椎骨折的手术治疗[3-4...