文章摘要

微创置钉治疗无神经损伤胸腰椎骨折患者的疗效

作者: 1钱重阳, 1杜瑞利
1 郑州煤炭工业(集团)有限责任公司总医院骨二科,郑州 452371
通讯: 钱重阳 Email: 3037566956@qq.com
DOI: 10.3978/j.issn.2095-6959.2019.12.019

摘要

目的:探讨微创置钉治疗无神经损伤的胸腰椎骨折患者的效果。方法:选取2016年6月至2018年6月在郑州煤炭工业(集团)有限责任公司总医院治疗的49例无神经损伤的胸腰椎骨折患者为观察组,另选取2014年5月至2016年5月的49例无神经损伤的胸腰椎骨折患者为对照组。对照组行传统后正中入路伤椎植骨内固定治疗,观察组从椎间隙旁入路行微创置钉治疗。统计两组术中失血量、手术时间、术后引流量等手术情况,并对比术前、术后不同时间段伤椎椎体前缘高度、后凸Cobb角、视觉模拟评分法(Visual Analogue Scale,VAS)、Oswestry功能障碍指数问卷表(Oswestry Disability Index,ODI)、血清磷酸肌酸激酶水平、椎旁肌肌电图检测异常波动情况。结果:观察组术中出血量、术后引流量、术后卧床时间较对照组少(P<0.05)。术后3,6个月,两组椎体前缘高度、后凸Cobb角的差异无统计学意义(P>0.05)。术后1,3,6个月,观察组VAS,ODI评分较对照组低(P<0.05)。术后1,3,5,7 d,观察组血清磷酸肌酸激酶水平较对照组低(P<0.05)。术后1,3,6个月,观察组椎旁肌电图异常波动比例低于对照组(P<0.05)。结论:微创置钉治疗无神经损伤的胸腰椎骨折患者,可减少术中出血量及术后引流量,加快术后康复进程,能减轻手术对椎旁肌及椎旁软组织损伤,保留多裂肌神经支配功能,降低术后腰椎疼痛及功能障碍程度。
关键词: 胸腰椎骨折;后正中入路伤椎植骨内固定治疗;微创置钉;椎旁肌;最长肌;多裂肌

Therapeutical effect of minimally invasive nailing on patients with thoracolumbar fracture without nerve injury

Authors: 1QIAN Chongyang, 1DU Ruili
1 Second Department of Orthopedics, General Hospital of Zhengzhou Coal Industry (Group) Co., Ltd., Zhengzhou 452371, China

CorrespondingAuthor: QIAN Chongyang Email: 3037566956@qq.com

DOI: 10.3978/j.issn.2095-6959.2019.12.019

Abstract

Objective: To investigate the effect of Minimally invasive nail for the treatment of thoracolumbar fractures without nerve injury. Methods: A total of 49 patients with thoracolumbar fractures without nerve damage treated in our hospital from June 2016 to June 2018 were selected as observation group, and 49 patients with thoracolumbar fractures without nerve injury treated from May 2014 to May 2016 were selected. The patient served as a control group. In the control group, the traditional posterior approach was used to treat the injured bone graft. The observation group was treated with minimally invasive nailing from the paravertebral space. The intraoperative blood loss, operation time, postoperative drainage and other surgical conditions were compared. The height of the vertebral body leading edge, the kyphosis Cobb angle, the Visual Analogue Scale (VAS), and the preoperative and postoperative time, Oswestry Dysfunction Index (ODI) questionnaire, serum phosphocreatine kinase levels, and paraspinal muscle EMG detection abnormal fluctuations were compared. Results: The amount of intraoperative blood loss, postoperative drainage, and postoperative bed rest in the observation group were less than those in the control group (P<0.05). There was no significant difference in the height of the anterior border and the kyphosis Cobb angle between the two groups in the 3rd and 6th months (P>0.05). One, 3, and 6 months after surgery The VAS and ODI scores of the observation group were lower than those of the control group (P<0.05). Serum phosphocreatine levels were lower in the observation group than in the control group at 1, 3, 5, and 7 days after surgery (P<0.05). The abnormal fluctuation rate of paravertebral EMG in the observation group at 1, 3, and 6 months after operation was lower than that of the control group (P<0.05). Conclusion: Minimally invasive nail for the treatment of thoracolumbar fractures without nerve injury can reduce intraoperative blood loss and postoperative drainage, accelerate postoperative rehabilitation, and reduce the damage to paravertebral muscles and paravertebral soft tissue. The multi-fracture muscle innervation function is preserved, and the degree of postoperative lumbar pain and dysfunction is reduced.
Keywords: thoracolumbar fracture; posterior median approach for vertebral bone grafting; minimally invasive nail; paraspinal muscle; longest muscle; multifidus