标题：微创置钉联合小切口入路椎板减压植骨内固定术治疗胸腰椎骨折合并神经损伤的效果研究

      作者：吴碧涛,刘德谦，蔡伟文，甘盛勇    东莞市樟木头人民医院外一科，广东 东莞 523633

      卷次： 2019年30卷13期

      【摘要】 目的 探究微创置钉联合小切口入路椎板减压植骨内固定术治疗胸腰椎骨折合并神经损伤的临床效果，为患者的临床治疗提供参考。方法 回顾性分析东莞市樟木头人民医院外一科2017年10月至2018年10月间收治的40例胸腰椎骨折合并神经损伤患者的临床治疗资料，按照患者治疗方式的不同将其分为观察组21例和对照组19例，观察组患者采取微创置钉联合小切口入路椎板减压植骨内固定术，对照组采取传统开放式进行治疗，比较两组患者的临床疗效、各项手术指标的变化、神经功能改善情况以及主观症状改善情况。结果 观察组患者治疗后的总有效率为90.5%，明显高于对照组的78.9%，差异有统计学意义(P<0.05)；观察组患者的手术时间与植骨量与对照组比较，差异均无统计学意义(P>0.05)，而患者的术中出血量和术后引流量分别为(360.7±159.1) mL、(96.8±31.8) mL，明显少于对照组的(515.9±246.2) mL、(271.3±69.5) mL，术后止痛药使用率为28.6%，明显少于对照组的57.9%，住院时间为(9.5±2.7) d，明显短于对照组的(11.4±3.3) d，两组比较差异均有统计学意义(P<0.05)；观察组患者ASIA分级评价显示无好转、1级好转、2级好转情况与对照组比较，差异均无统计学意义(P>0.05)；观察组患者术前 JOA评分为(13.1±4.2)分，与对照组的(12.5±3.2)分比较，差异无统计学意义(P>0.05)，而观察组患者术后 JOA评分为(26.3±1.3)分，明显高于对照组的(21.6±1.5)分，差异有统计学意义(P<0.05)。结论 微创置钉联合小切口入路椎板减压植骨内固定术治疗胸腰椎骨折合并神经损伤患者具有良好的效果，患者术后创伤较小、出血量较少、恢复较快，值得临床治疗中推广。
      【关键词】 微创置钉；植骨；椎板减压；胸腰椎骨折；神经损伤
      【中图分类号】 R683.2 【文献标识码】 A 【文章编号】 1003—6350（2019）13—1684—04

Effect of minimally invasive screw placement combined with decompressive laminectomy, bone grafting andinternal fixation operation through a small incision in the treatment of thoracolumbar fracture complicatingnerve injury.
WU Bi-tao, LIU De-qian, CAI Wei-wen, GAN Sheng-yong. Department of Surgery, Dongguany ZhangmutouPeople's Hospital, Dongguan 523633, Guangdong, CHINA
【Abstract】 Objective To investigate the clinical effect of minimally invasive screw placement combined withdecompressive laminectomy, bone grafting and internal fixation operation through a small incision in the treatment ofthoracolumbar fracture combined with nerve injury, and provide reference for clinical treatment. Methods A retrospec-tive analysis was conducted by using the clinical treatment data of 40 patients with thoracolumbar fracture and nerve in-jury, who were admitted to the Department of Surgery at Dongguan Zhangmutou People's Hospital from October 2017 toOctober 2018. According to the different treatment methods, the patients were divided into observation group (n=21) andcontrol group (n=19). Patients in the observation group underwent minimally invasive screw placement combined withdecompressive laminectomy, bone grafting and internal fixation operation through a small incision; and patients in thecontrol group were treated with traditional open treatment. The clinical efficacy, changes of various surgical indexes, im-provement of neurological function, and improvement of subjective symptoms were compared between the two groups.Results The total effective rate of the observation group was 90.5% after treatment, which was significantly higherthan 78.9% of the control group, and the difference was statistically significant (P<0.05). The differences in the opera-tion time and bone graft volumes between the observation group and the control group were not statistically significant(P>0.05). In the observation group, the intraoperative blood loss and postoperative drainage volume were respectively(360.7 ± 159.1) mL and (96.8 ± 31.8) mL, which were significantly less than corresponding (515.9 ± 246.2) mL and(271.3±69.5) mL in the control group; the use rate of postoperative analgesics was 28.6%, which was significantly lessthan 57.9% in the control group; the hospitalization time was (9.5 ± 2.7) days, which was significantly shorter than(11.4±3.3) days in the control group; all differences between the two groups were statistically significant (P<0.05). TheASIA grades in the observation group, including no improvement, grade 1 improvement, and grade 2 improvement,were not statistically significantly compared with those in the control group (P>0.05). The preoperative JOA score was(13.1±4.2) points in the observation group versus (12.5±3.2) points in the control group, and the difference was not