微创经皮椎弓根螺钉内固定与后路切开复位内固定在胸腰椎压缩性骨折患者中的应用价值

Application Value of Minimally Invasive Percutaneous Pedicle Screw Internal Fixation and Posterior Open Reduction and Internal Fixation in Patients with Thoracolumbar Compression Fractures

目的探讨微创经皮椎弓根螺钉内固定与后路切开复位内固定治疗胸腰椎压缩性骨折患者的临床效果.方法选取该院2020年1月—2021年12月收治的80例胸腰椎压缩性骨折患者为研究对象,依据不同治疗方法将其分为A组(n=40)、B组(n=40).A组采用后路切开复位内固定治疗,B组采用微创经皮椎弓根螺钉内固定治疗.两组术后均随访6个月.比较两组围手术期相关指标、胸腰椎椎体解剖学结构变化、胸腰椎功能障碍程度以及并发症发生率.结果B组术中出血量、术后引流量均较A组少,术后住院时间较A组短,组间差异有统计学意义(P<0.05);B组手术时间与A组比较,差异无统计学意义(P>0.05).术前1 d、术后6个月B组胸腰椎椎体前缘高度比、后凸Cobb's角与A组比较,组间差异无统计学意义(P>0.05).术前1 d,B组胸腰椎Oswestry功能障碍指数问卷表(ODI)评分与A组比较,差异无统计学意义(P>0.05);术后6个月,B组ODI评分较A组低,差异有统计学意义(P<0.05).B组术后并发症发生率较A组低,差异有统计学意义(P<0.05).结论对于胸腰椎压缩性骨折患者,后路切开复位内固定与微创经皮椎弓根螺钉内固定治疗均可促进其胸腰椎椎体解剖学结构恢复,但后者手术创伤小,胸腰椎功能恢复更佳,且并发症发生率较低.

Objective To explore the clinical effect of minimally invasive percutaneous pedicle screw internal fixation and posterior open reduction and internal fixation in the treatment of patients with thoracolumbar compression fractures.Methods 80 patients with thoracolumbar compression fracture admitted to the hospital from January 2020 to December 2021 were selected as the research objects and divided into a group A(n=40)and a group B(n=40)according to different treatment methods.Group A was treated with posterior open reduction and internal fixation,and group B was treated with minimally invasive percutaneous pedicle screw internal fixation.Both groups were followed up for 6 months.Perioperative related indexes,anatomical structure changes of thoracolumbar vertebrae,degree of thoracolumbar vertebrae dysfunction and incidence of complications were compared between the two groups.Results The intraoperative blood loss and postoperative drainage volume of group B were less than those of group A,and the postoperative hospital stay of group B was shorter than that of group A,and the differences between the groups were statistically significant(P<0.05);there was no statistical significance in the operation time between group B and group A(P>0.05).1 day before surgery and 6 months after surgery,there was no significant difference between group B and group A in thoracolumbar vertebrae anterior margin height ratio and kyphotic Cobb's angle(P>0.05).1 day before surgery,there was no significant difference in thoracolumbar Oswestry dability index(ODI)score between group B and group A(P>0.05);6 months after surgery,ODI score of group B was lower than that of group A,the difference was statistically significant(P<0.05).The incidence of postoperative complications in group B was lower than that in group A,and the difference was statistically significant(P<0.05).Conclusion For patients with thoracolumbar compression fractures,posterior open reduction and internal fixation and minimally invasive percutaneous pedicle screw internal fixation can promote the recovery of anatomical structure of thoracolumbar vertebrae,but the latter has less surgical trauma,better thoracolumbar functional recovery,and a lower incidence of complications.