改良经皮椎弓根螺钉内固定（mMIPPSO）治疗无神经障碍胸腰段骨折.docVIP

改良经皮椎弓根螺钉内固定（mMIPPSO）治疗无神经障碍胸腰段骨折 论文联盟www.LWLM.com编辑。 作者：薛华明，涂意辉，蔡珉巍，杨安礼 【摘要】 ［目的］探讨改良微创经皮椎弓根螺钉内固定（mMIPPSO）技术 治疗 胸腰段无神经障碍的压缩性骨折的可行性及疗效。［方法］自2005年6月～2007年6月，选择12例无神经系统症状的胸腰段压缩性骨折，无需减压的患者，在C型臂X线机引导下，采用改良的手术器械，作4个1～1.5 cm长的纵行小切口，完成椎弓根螺钉的置入。并与同期的18例行传统切口椎弓根螺钉内固定技术的患者比较围手术期参数，影像学指标，视觉模拟评分法(VAS)，Oswestry下腰痛评分(ODI)。［结果］所有患者均获得了完整的随访，随访时间为8～25个月，平均13.2个月。微创经皮组较传统开放组不仅手术时间，住院时间明显缩短，而且在术中出血，术后伤口引流量均显著减少（P0.01）。2组患者各自在术后后凸Cobb′s角，椎体前缘高度，椎间隙高度等较术前均有显著的恢复（P0.01），同时术后VAS评分，ODI残障指数较术前明显减少（P0.01）。2组的骨折愈合时间无明显差异(P0.05)。［结论］改良微创经皮椎弓根螺钉内固定技术操作相对简便，具有创伤小，出血少，手术时间短，术后恢复快等近期优点，但远期疗效尚需进一步随访。 【关键词】 经皮内固定术； 椎弓根螺钉； 改良； 微创； 胸腰椎骨折 Abstract：［Objective］To explore the feasibility and effect of modified minimally invasive percutaneous pedicle screws osteosynthesis for the treatment of thoracolumbar vertebra compression fracture.［Method］Twelve cases of thoracolumbar fracture without neural impairment were enrolled who did not need laminotomy decompression from June 2005 to June 2007.With the help of Carm image intensifier,the pedicle screws were inserted through four small longitudinal incisions(1-1.5 cm) and modified surgical instruments.Perioperative parameter,postoperative imaging index,visual analog scale(VAS) and Oswestry Disability Index(ODI) were compared with the treatment of conventional open pedicle screws osteosynthesis in other 18 cases.［Result］All cases were followed up from 8 to 25 months(mean 13.2 months).The operation time and length of stay in minimal invasive group were significantly shorter than that in conventional group,the amount of operative bleeding and drainage of postoperation decreased obviously (P0.01).In each group,comparison of Cobb′s angle,anterior vertebra hEight,disc hEIght,VAS and ODI scores between pre and post operation were all significantly different (P0.01).There was no significant difference in bone union between two groups (P0.05).［Conclusion］This study shows that percutaneous internal pedicle screw fixation using modified instruments has the advan