经皮与开放椎弓根螺钉系统治疗多节段胸腰椎骨折:置钉准确率对比

Comparison of percutaneous and open pedicle screw system in the treatment of multilevel thoracolumbar fractures: the accuracy of screw placement

背景:多节段胸腰椎骨折以经皮椎弓根螺钉和开放椎弓根螺钉系统治疗为主,但是不同内固定系统的治疗效果及置钉准确率存在争议,导致患者选择何种治疗方法缺乏统一标准。目的:探讨经皮椎弓根螺钉和开放椎弓根螺钉系统在多节段胸腰椎骨折中的应用效果及其对置钉准确率的影响。方法:纳入多节段胸腰椎骨折患者90例,根据置钉方法分为2组,开放椎弓根螺钉组43例采用开放椎弓根螺钉置入治疗,经皮椎弓根螺钉组47例采用经皮椎弓根螺钉置入治疗。通过比较2组围术期指标(手术时间、术后引流量、手术切口长度等)、影像学指标(伤椎前缘高度百分比、伤椎后缘高度百分比、矢状位)、术后并发症及置钉准确率等进行综合疗效分析。结果与结论:(1)经皮椎弓根螺钉组术中出血量、术后引流量、手术切口长度均少(短)于开放椎弓根螺钉组(P<0.05),但手术时间、术中透视次数长(多)于开放椎弓根螺钉组(P<0.05);(2)经皮椎弓根螺钉组术后2个月伤椎前缘高度百分比、伤椎后缘高度百分比均高于开放椎弓根螺钉组(P<0.05),但术后2个月矢状位Cobb角小于开放椎弓根螺钉组(P<0.05);(3)经皮椎弓根螺钉组术后2个月并发症发生率为4%,与开放椎弓根螺钉组14%比较,差异有显著性意义(P<0.05);(4)经皮椎弓根螺钉组置钉准确率为92.1%(共置入279枚螺钉),高于开放椎弓根螺钉组77.0%(共置入257枚螺钉),差异有显著性意义(P<0.05);(5)结果提示,将经皮椎弓根螺钉系统用于修复多节段胸腰椎骨折具有创伤小、恢复快等特点,有助于伤椎复位,维持椎体高度,安全性及置钉准确率高。

BACKGROUND:Multilevel thoracolumbar fractures are mainly treated with percutaneous pedicle screw and open pedicle screw system,but the treatment effect of different systems and the accuracy rate of screw placement are controversial,resulting in the lack of uniform standards for choosing the treatment method.OBJECTIVE:To evaluate the effect of percutaneous pedicle screw and open pedicle screw system in the treatment of multilevel thoracolumbar fractures and to evaluate the accuracy of the screw placement.METHODS:Totally 90 patients with multilevel thoracolumbar fractures were divided into open pedicle screw group(n=43 cases)and percutaneous pedicle screw group(n=47)according to different surgical methods.Open pedicle screw group was treated with open pedicle screw treatment,and percutaneous pedicle screw group was treated with percutaneous pedicle screw.Comprehensive effects were analyzed by comparing perioperative indicators(operation time,postoperative drainage volume,and incision length)imaging index(anterior vertebral height percentage,posterior vertebral height percentage,sagittal Cobb angle),postoperative complications,and pedicle screw accuracy.RESULTS AND CONCLUSION:(1)The amount of bleeding,postoperative drainage volume,and incision length were less(shorter)in the percutaneous pedicle screw group compared with the open pedicle screw group(P<0.05).However,operation time and the number of undergoing fluoroscopy were longer(more)in the percutaneous pedicle screw group than in the open pedicle screw group(P<0.05).(2)Anterior vertebral height percentage and posterior vertebral height percentage were higher in the percutaneous pedicle screw group than in the open pedicle screw group(P<0.05).Sagittal Cobb angle was smaller in the percutaneous pedicle screw group than in the open pedicle screw group(P<0.05).(3)At 2 months after surgery,the complication rate was significantly lower in the percutaneous pedicle screw group(4%)than in the open pedicle screw group(14%)(P<0.05).(4)The accuracy rate of pedicle screw was significantly higher in the percutaneous pedicle screw group(92.1%;279 screws)than in the open pedicle screw group(77.0%;257 screws)(P<0.05).(5)Results indicated that percutaneous pedicle screw fixation is characterized by less trauma and rapid recovery in the treatment of multilevel thoracolumbar fractures.It is helpful for the reduction of the injured vertebra,the maintenance of vertebral height;the safety and the accuracy of screw placement are high.