1、15临床研究 2023 年 03 月第 31 卷第 03 期基金项目：胸腔镜下前路微创治疗胸椎结核的临床研究(LHGJ20210228)。作者简介：徐林飞，男，主治医师，硕士研究生。研究方向：骨科脊柱外科骨结核。15CHUANSUMRIT A,SASANAKUL W,SIRACHAINAN N,et al.Association of factor and factor mutations,HLA Class,tumour necrosis factor-and interleukin-10 on inhibitor development among Thai haemophilia A a
2、nd B patientsJ.Haemophilia,2017,23(6):e518-e523.16KARIN,KURNIK,(DR),et al.Presence of factor V leiden or prothrombin mutation influence inhibitor development in children with severe hemophilia A:data of a multicenter cohort studyJ.Blood,2008,112(11):242.17周娟.重型血友病A患儿关节出血后IL-1、IL-6、TNF-释放与关节病变形成的相关性研
3、究J.中外医疗,2019,38(7):13-15.18李卓,肖娟,赵永强,等.中国重型血友病A患儿规律预防治疗的选择及其影响因素分析-来自中国12家血友病中心的调查和分析J.中国小儿血液与肿瘤杂志,2017,22(4):173-179.19刘国青,陈振萍,唐凌,等.重型血友病A患儿关节出血后IL-1、IL-6、TNF-释放与关节病变形成的相关性研究J.首都医科大学学报,2018,39(3):314-319.20COLLINS P W,PALMER B P,CHALMERS E A,et al.Factor brand and the incidence of factor inhibitors
4、 in previously untreated UK children with severe hemophilia A,2000-2011J.Blood,2014,124(23):3389-3397.21闫朝奇,冷青,由国平,等.鞍山地区2013年1月2018年1月血友病诊疗的临床回顾分析J.中国当代医药,2018,25(21):158-160.22胡楠,姚婉茹,张宁宁,等.中重型血友病A患儿关节出血情况与关节结构、功能相关性研究J.中国小儿血液与肿瘤杂志,2018,23(1):12-16,22.23李彦明,何瑞利,钟晓鸣,等.ACS患者外周血中vWF-cp、Cat K、CysC及P选择素
5、的变化及与冠脉病变的关系J.东南大学学报(医学版),2019,38(1):38-42.24杨秋林,吴锋,吴彬彬,等.创伤性凝血病患者外周APC、vWF、D-D水平变化与凝血功能及预后的相关性分析J.全科医学临床与教育,2022,20(1):18-21.论著比较经皮与开放椎弓钉固定治疗无神经损伤胸椎骨折的临床效果徐林飞1，沈皆亮2(1.河南省胸科医院 骨科，河南 郑州 450000；2.重庆医科大学附属第一医院 骨科，重庆 400016)摘要：目的 比较经皮与开放椎弓钉固定治疗无神经损伤胸椎骨折的临床效果。方法 选取 2021 年 3 月至 2022 年9 月河南省胸科医院收治的 86 例无神经
6、损伤胸椎骨折患者，按照随机数字表法分成研究组(N=43)与对照组(N=43)，对照组给予开放椎弓钉固定治疗，研究组给予经皮椎弓钉固定治疗，对两组围手术期指标、疼痛程度 视觉模拟评分法(VAS)评分、后凸 Cobb 角、伤椎前缘高度及并发症进行比较。结果 与对照组比较，研究组手术及住院时间、切口长度均更短，差异有统计学意义(P 0.05)，术中出血量更少，差异有统计学意义(P 0.05)。术后两组 VAS 评分均降低，差异有统计学意义(P 0.05)，研究组 VAS 评分较对照组更低，差异有统计学意义(P 0.05)。术后两组后凸 Cobb 角均降低，差异有统计学意义(P 0.05)，伤椎前缘高
7、度均提高，差异有统计学意义(P 0.05)，但研究组后凸 Cobb 角、伤椎前缘高度与对照组比较差异无统计学意义(P 0.05)。研究组并发症发生率(6.98%)低于对照组(23.26%)，差异有统计学意义(P 0.05)。结论 与开放椎弓钉固定相比，经皮椎弓钉固定用于治疗无神经损伤胸椎骨折能够缩短手术、住院时间，减小手术创口，减少术中出血量，减轻疼痛感，改善后凸 Cobb 角及伤椎前缘高度，减少并发症发生。关键词：无神经损伤；胸椎骨折；经皮椎弓钉固定；开放椎弓钉固定中图分类号：R683.1文献标志码：A DOI：10.12385/j.issn.2096-1278(2023)03-0015-0
8、4To compare the clinical Effect of percutaneous and open pedicle Screw Fixation in the Treatment of thoracic vertebral Fracture without Nerve InjuryXU Linfei1,SHEN Jieliang2(1.Department of Orthopedics,Henan Provincial Thoracic Hospital,Henan 471000,China;2.Department of Orthopedics,The First Affili
9、ated Hospital of Chongqing Medical University,Henan 471000,China)Abstract:Objective To compare the clinical effects of percutaneous and open pedicle screw fixation in the treatment of thoracic vertebral fracture without nerve injury.Methods A total of 86 patients with thoracic vertebral fracture wit
10、hout nerve injury admitted to Henan Provincial Thoracic Hospital from March 2021 to September 2022 were randomly divided into the study group(N=43)and the control group(N=43)according to the random number table.The control group was treated with open pedicle screw fixation.The study group was treate
11、d with percutaneous pedicle screw fixation.Perioperative indexes,pain degree VAS score,kyphosis Cobb angle,the height of the anterior edge of the injured vertebra and its complications were compared.Results Compared with the control group,the operation and hospitalization time and incision length of
12、 the study group were shorter,the difference was statistically significant(P 0.05).The VAS score of the two groups decreased significantly after operation,the difference was statistically significant(P 0.05).The VAS score of the study group was lower than that of the 16Clinical Research,Mar.2023,Vol
13、.31 No.03control group,the difference was statistically significant(P 0.05).After operation,the kyphotic Cobb angle of the two groups decreased significantly,the difference was statistically significant(P 0.05).The height of the anterior edge of the injured vertebrae increased significantly,the diff
14、erence was statistically significant(P 0.05),but there was no significant difference in the Cobb angle of the kyphosis and the height of the anterior edge of the injured vertebrae between the study group and the control group(P 0.05).The incidence of complications in the study group(6.98%)was lower
15、than that in the control group(23.26%),and the difference was statistically significant(P 0.05).Conclusion Compared with open pedicle screw fixation,percutaneous pedicle screw fixation for the treatment of thoracic vertebral fracture without nerve injury can shorten the time of operation and hospita
16、lization,reduce the surgical wound,reduce the amount of intraoperative bleeding,reduce pain,improve the kyphotic Cobb angle and the height of the anterior edge of the injured vertebra,and reduce complications.Key Words:without nerve injury;thoracic vertebra fracture;percutaneous pedicle screw fixation;open pedicle screw fixation胸椎骨折属于常见骨折类型之一，主要由外力冲击(车祸、高处坠落、跌倒等)所引起，容易对脊柱造成严重损伤，患者若无法得到及时有效的治疗，可引起长期慢性疼痛，严重时甚至丧失活动能力，对其日常生活、生命质量造成不良影响1。若患者无神经损伤状况，可采用保守治疗，但该方式恢复时间较长，难以保持患处稳定性，效果不佳，因此，临床仍将手术作为治疗胸椎骨折的
