摘要
目的:分析后路通道下椎管减压结合经皮椎弓根螺钉固定治疗严重椎管狭窄伴神经损伤的胸腰椎骨折患者效果;方法:选取2014年3月至2018年3月收治的80例严重椎管狭窄伴神经损伤的胸腰椎骨折患者,随机分为观察组和对照组,观察组患者采用后路通道下椎管减压联合经皮椎弓根螺钉固定治疗,对照组患者采用开放式椎管减压椎弓根螺钉固定治疗,比较两组患者的围手术期指标,术前、术后1周VAS评分,术前、术后1周、3个月、12个月伤椎前缘高度及Cobb角;术前、术后1周、12个月椎管通畅率,术前、术后1周神经功能恢复情况,术后并发症发生情况。结果:观察组患者手术时间较对照组延长,切口长度、住院时间较对照组缩短(P<0.05),术中出血量、术后引流量较对照组减少(P<0.05),自体血回输率、术后止痛药使用率较对照组低(P<0.05);两组患者术后1周VAS评分均下降(P<0.05),术后1周、3个月、12个月两组患者伤椎前缘高度及Cobb角均改善(P<0.05),术后1周、12个月两组患者的椎管通畅率均改善(P<0.05);两组患者术后1周神经功能均改善(P<0.05);两组患者术后并发症发生率相比,差异无统计学意义(P>0.05)。结论:后路通道下椎管减压结合经皮椎弓根螺钉固定治疗严重椎管狭窄伴神经损伤的胸腰椎骨折均能解除脊神经压迫症状,恢复椎管通畅,降低患者术后疼痛,更有利于术后的恢复,值得临床推广。
Objective:To investigate the effect of posterior spinal cannal decompression combined with percutaneous pedicle screw fixation on patients with thoracolumbar fractures combined with severe spinal stenosis and neurological injury.Methods:80 patients with thoracolumbar fractures with severe spinal canal stenosis and neurological injury hospitalized from March 2014 to March 2018 were chosen and randomly divided into the observation group and the control group.The observation group were treated with posterior spinal canal decompression combined with percutaneous pedicle screw fixation,while the control group were treated with open spinal decompression and pedicle screw fixation,with the perioperative indicators,the VAS scores before and 1 week after surgery,the height of the injured anterior borders and the Cobb angles before,1 week,3 months,and 12 months after surgery,the 12-month spinal patency rates before and 1 week after surgery,neurological recovery before and 1 week after surgery and postoperative complications compared.Results:The operation time of the observation group was significantly longer than that of the control group.The lengths of the incision and of hospital stay were significantly shorter than those of the control group(P<0.05).The intraoperative blood loss and postoperative drainage in the observation group were significantly lower than those of the control group(P<0.05).The autologous blood transfusion rate and the postoperative painkiller used rate in the observation group were significantly lower than those of the control group(P<0.05).The VAS scores of the two groups were significantly decreased the first week after operation(P<0.05).The height of the anterior borders and the Cobb angles in both groups 1 week,3 months,and 12 months after operation were significantly improved(P<0.05).The patency rate of spinal canals 1 week and 12 weeks after surgery in both groups were significantly improved(P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusion:Posterior spinal canal decompression combined with percutaneous pedicle screw fixation for thoracolumbar fractures with severe spinal canal stenosis combined with neuraological injury can relieve spinal nerve compression,restore spinal canal patency,and thus more conducive to postoperative recovery and worthy of clinical promotion.
作者
刘选
刘仁德
蔡广荣
LIU Xuan;LIU Rende;CAI Guangrong(Dongguan Mayong Hospital,Guangdong,Dongguan 523000,China)
出处
《包头医学院学报》
CAS
2019年第9期6-9,共4页
Journal of Baotou Medical College
关键词
椎管狭窄
神经损伤
胸腰椎骨折
经皮椎弓根螺钉固定
椎管减压
Spinal canal stenosis
Nerve injury
Thoracolumbar fractures
Percutaneous pedicle screw fixation
Spinal canal decompression
