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目的评价中西医结合“三步复位法”治疗胸腰段脊柱爆裂骨折复位方法的临床疗效,探讨其科学性。方法对60例胸腰段脊柱爆裂骨折患者实施中西医结合“三步复位法”治疗,中医手法复位结合经伤椎椎弓根钉固定手术治疗。观察患者术前术后各临床指标变化情况。结果术后60例患者疼痛明显缓解,VAS评分由术前的8.3分降到术后的3.2分,差异有统计学意义(P<0.05);术后伤椎前缘平均高度恢复到93.5%,脊柱后凸角(Cobbs角)恢复到6.4°,椎管正中矢状径恢复到92%,与手术前伤椎前缘高度压缩平均45.6%,脊柱后凸角(Cobb角)平均27.6°,椎管正中矢状径平均76.4%比较,差异有统计学意义(P<0.05)。术后骨折均获得复位,所有患者未发生内固定断裂并发症,植骨融合效果满意。结论中西医结合“三步复位法”手法复位结合椎弓根钉系统内固定术,能让脊柱胸腰段爆裂骨折获得满意复位,重建椎体高度,恢复脊柱生物力学性能,减少内固定因应力过大造成的断钉、矫正丢失等并发症,是一种治疗胸腰椎爆裂骨折的有效方法。
Objective To evaluate the clinical efficacy of integrated traditional Chinese and western medicine in the treatment of thoracolumbar burst fractures of the spine by the three-step reduction method and to explore its scientificity. Methods Sixty patients with thoracolumbar spine burst fracture were treated with integrated traditional and western medicine and three-step reduction method. The Chinese medicine method was combined with the operation of transpedicular pedicle screw fixation. Observation of patients before and after the changes of clinical indicators. Results The pain of 60 patients was relieved obviously. The VAS score decreased from 8.3 before surgery to 3.2 after surgery, the difference was statistically significant (P <0.05). The average height of the anterior vertebral body recovered to 93.5% The Cobbs angle recovered to 6.4 °, and the median sagittal diameter of the spinal canal recovered to 92%. The average height of the vertebral canal was 45.6% and the Cobb angle was 27.6 °. The median sagittal diameter was 76.4%, the difference was statistically significant (P <0.05). Postoperative fractures were reset, all patients with no complications of fracture fixation, bone graft fusion satisfactory results. Conclusion Integrative Chinese and Western medicine “three-step reduction method” manual reduction combined with pedicle screw system fixation, can make the thoracolumbar burst fractures of the spine to obtain a satisfactory reduction, reconstruction of vertebral body height, restore spinal biomechanical properties, reduce internal fixation Due to stress caused by broken nails, loss of complications such as correction, is an effective treatment of thoracolumbar burst fractures.