微创经皮与开放椎弓根螺钉内固定技术治疗胸腰段脊柱骨折的临床疗效对比

Comparison of the clinical efficacy between percutaneous and traditional open pedicle screw fixation for the treatment of thoracolumbar vertebral fractures

目的比较传统后路开放椎弓根螺钉内固定技术与经皮穿刺椎弓根螺钉内固定技术治疗单节段胸腰段脊柱骨折的临床疗效。方法选取2014年10月—2016年10月行椎弓根螺钉内固定术的脊柱胸腰段骨折患者,共30例,其中经皮组15例,开放组15例。比较2组患者影像学结果、围手术期参数(失血量、在院时间、手术耗时等)、VAS评分。结果2组手术耗时比较,差异无统计学意义(P>0.05),但是围手术期失血量和在院时间比较,差异有统计学意义(P<0.01)。手术前及手术后3个月,2组VAS评分差异均无统计学意义(P>0.05)。术后1周及1个月,经皮组VAS评分为(1.91±0.27)分和(1.55±0.19)分,明显低于切开复位组的(2.82±0.39)和(2.31±0.33),差异具有统计学意义(P<0.01)。2组患者术后伤椎椎体前缘高度百分比及伤椎后凸角较术前恢复明显,但2组患者术后即刻、术后半年、术后1年所测得的伤椎后凸角、伤椎椎体前缘高度,经比较差异无统计学意义(P>0.05)。结论经皮穿刺、椎弓根螺钉内固定技术是治疗胸腰椎骨折的理想微创手术方式,在治疗胸腰椎骨折时切口小,出血量少、术后并发症少、恢复快,值得临床推广。

Objective To compare the clinical efficacy of percutaneous pedicle screw fixation and traditional open surgery for the treatment of single segment thoracolumbar vertebral fractures.Methods A total of 30 patients who received pedicle screw fixation due to thoracolumbar fractures from October 2014 to October 2016 were selected,including 15 patients in a traditional open surgery group and 15 patients in a percutaneous pedicle screw fixation group.Then,both groups were compared for intraoperative parameters,imaging indicators(blood loss,the length of hospitalization stay and the duration of surgery)and visual analogue scale(VAS)scores.Results No statistical difference was found as to the duration of surgery between the two groups(P>0.05),but significant differences were found in intraoperative blood loss and the length of hospitalization stay(P<0.01).There was no statistical difference in VAS score between the two groups before and three months after surgery(P<0.05).The VAS score was 1.91±0.27 and 1.55±0.19 in the percutaneous pedicle fixation group one week and one month after surgery,which was remarkably lower than those in the traditional open surgery group(2.81±0.37 and 2.31±0.30,P<0.01).The radiographic vertebral height and Kyphosis Cobb angle were recovered obviously after surgery,but no significant differences were found between the two groups immediately,half of a year and one year after surgery(P>0.05).Conclusions Percutaneous pedicle screw fixation is characterized in small incision,little blood loss and postoperative pain and fast recovery,which is effective to be applied in thoracolumbar fractures.