中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (24): 3865-3869.doi: 10.12307/2021.094

• 脊柱植入物 spinal implant • 上一篇    下一篇

微创经皮伤椎置钉治疗胸腰椎骨折：6个月随访脊柱生物力学变化

邹守平，卢道云，叶  力   

  1. 解放军东部战区海军医院骨科，浙江省舟山市   316000
  • 收稿日期:2020-09-07 修回日期:2020-09-09 接受日期:2020-10-16 出版日期:2021-08-28 发布日期:2021-03-17
  • 通讯作者: 卢道云，副主任医师，解放军东部战区海军医院骨科，浙江省舟山市 316000
  • 作者简介:邹守平，男，1973年生，江西省丰城市人，汉族，1996年江西医学院毕业，副主任医师，主要从事脊柱外科方面的研究。

Minimally invasive percutaneous pedicle screw technique for thoracolumbar fractures: biomechanical changes of the spine during 6-month follow-up

Zou Shouping, Lu Daoyun, Ye Li   

  1. Department of Orthopedics, Naval Hospital of Eastern Theater Command, Zhoushan 316000, Zhejiang Province, China
  • Received:2020-09-07 Revised:2020-09-09 Accepted:2020-10-16 Online:2021-08-28 Published:2021-03-17
  • Contact: Lu Daoyun, Associate chief physician, Department of Orthopedics, Naval Hospital of Eastern Theater Command, Zhoushan 316000, Zhejiang Province, China
  • About author:Zou Shouping, Associate chief physician, Department of Orthopedics, Naval Hospital of Eastern Theater Command, Zhoushan 316000, Zhejiang Province, China

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摘要：

文题释义：
经皮置钉：为骨科微创技术的一种方式，在术中影像学引导的条件下，将需要置入的螺钉系统经体表的小切口直接置入靶向区域进行固定。
胸腰椎骨折：是脊柱常见骨折类型，为主要位于脊柱胸腰段(T11-L3节段)的骨折。

背景：脊柱微创外科的迅速发展，对于脊柱骨折尤其是胸腰椎骨折的治疗在器械和理念上近年来都不断迅速更新，减少了手术创伤、缩短康复时间、提高了治疗满意度。
目的：对比微创经皮与开放伤椎置钉在无神经损伤胸腰椎骨折治疗中的应用效果。
方法：回顾性分析解放军东部战区海军医院2015年1月至2018年12月收治的52例无神经损伤胸腰椎骨折患者的病历资料，根据置钉技术分为2组，观察组24例行微创经皮伤椎置入椎弓根螺钉内固定治疗，对照组28例行开放伤椎置入椎弓根螺钉内固定治疗。对比两组患者的围术期指标(手术时间、术中出血量、术中透视次数、术后住院日、切口愈合率)，并随访患者术后腰背痛目测类比评分、椎体前缘高度百分比及矢状面后凸Cobb角。
结果与结论：①观察组的围术期指标中手术时间、术中透视次数多于对照组(P < 0.05)，但是术中出血量、术后住院日和切口愈合率均优于对照组(P < 0.05)；②所有患者均完成12个月以上随访，观察组术后3 d、1个月、3个月、6个月、12个月的腰背痛目测类比评分均优于对照组(P < 0.05)，而椎体前缘高度百分比、矢状面后凸Cobb角相比两组差异无显著性意义(P > 0.05)；③结果提示，微创经皮伤椎置钉治疗无神经损伤的胸腰椎骨折可减少手术创伤，虽然在透视次数、手术时间方面有所增加，但是临床疗效肯定。
https://orcid.org/0000-0002-7979-7432 (邹守平) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 胸腰椎骨折, 微创, 经皮, 椎弓根螺钉, 内固定, 伤椎置钉, 随访

Abstract: BACKGROUND: The rapid development of spine minimally invasive surgery, the treatment of spinal fractures, especially thoracolumbar fractures, has been rapidly updated in recent years in equipment and concepts, reducing surgical trauma, shortening recovery time, and improving treatment satisfaction. 
OBJECTIVE: To analyze the therapeutic effect of percutaneous pedicle screw placement and open wound placement in the treatment of thoracolumbar fractures without nerve injury.  
METHODS: A retrospective analysis of 52 patients with thoracolumbar fractures without nerve injury who were admitted to Naval Hospital of Eastern Theater Command from January 2015 to December 2018. According to nail placement technology, the patients were divided into two groups. The 24 patients in the observation group received percutaneous pedicle screw placement combined with injured vertebrae nail placement technology. The 28 patients in the control group received open injured vertebrae nail placement. Perioperative indicators (operation time, intraoperative blood loss, intraoperative fluoroscopy, postoperative hospital stay, and incision healing rate) were compared between the two groups. Postoperative low back pain visual analogous scale score, anterior vertebral height percentage, and sagittal kyphotic Cobb angle were analyzed during follow-up.  
RESULTS AND CONCLUSION: (1) The operation time and the number of intraoperative fluoroscopy were more in the observation group than those of the control group (P < 0.05), but the blood loss, postoperative hospital stay and incision healing rate were better in the observation group than those of the control group (P < 0.05). (2) All patients completed a follow-up for more than 12 months. The visual analogous scale scores of low back pain at 3 days, 1, 3, 6, and 12 months after surgery in the observation group were better than those in the control group (P < 0.05). There was no significant difference in the anterior body height percentage and the sagittal kyphosis Cobb angle between the two groups (P > 0.05). (3) The results suggest that the minimally invasive percutaneous vertebral nail placement technique reduces surgical trauma, although there are differences in fluoroscopy and operation time. However, the clinical effect is affirmative.

Key words: thoracolumbar vertebral fractures, minimally invasive, percutaneous, pedicle screw, internal fixation, vertebral nail placement, follow-up

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