微创经皮与传统开放椎弓根螺钉内固定治疗胸腰椎骨折的临床对比研究

Comparision of minimally invasive percutaneous and traditional open treatment for thoracolumbar fractures with pedicle screw system

背景:随着微创脊柱外科技术的发展,经皮椎弓根螺钉固定技术逐步被广泛应用于脊柱骨折的治疗。目的:本文旨在比较微创经皮椎弓根螺钉内固定术与传统开放椎弓根螺钉内固定治疗胸腰椎骨折的中期临床疗效。方法:2008年3月至2010年3月收治无神经系统损伤的胸腰椎骨折患者86例,其中46例采用微创经皮椎弓根螺钉内固定术治疗,40例采用传统开放椎弓根螺钉内固定手术,对两组患者围手术期相关指标、中期随访的影像学指标、腰背疼痛改善情况进行比较。结果:所有患者均获得随访,平均随访时间32个月(18～44个月)。两组一般资料比较差异无统计学意义。微创组与传统组比较,手术时间无明显差异,但在手术切口长度、术中出血量、术后并发症、术后引流量、术后住院时间等指标均有显著性差异(P<0.05)。两组术前与术后影像学比较,矢状位后凸Cobb角、矢状位指数、伤椎椎体前缘高度均有显著性差异(P<0.05),微创组术后Cobb角、伤椎前缘高度、矢状面指数的改善程度与开放手术组比较差异无统计学意义(P>0.05),中期随访期间两组矫正度丢失无统计学差异(P>0.05)。微创组术后疼痛缓解更明显,两组比较有统计学差异,但术后1年随访时两组趋于一致,无明显统计学差异。结论:微创经皮椎弓根螺钉固定治疗胸腰椎骨折安全可靠、创伤小、出血少、恢复快、住院时间短、术后并发症少,中期随访对伤椎畸形的矫正和内固定效果与传统开放手术相当。

Background： With the development of minimally invasive spinal technique, percutaneous pedicle screw fixation has been widely used for the treatment of spinal fractures. Objective： The present study is to compare the midterm clinical results between minimally invasive percutaneous and traditional open pedicle screw fixation in the treatment of thoracolumbar fracture. Methods： From March 2008 to March 2010, 86 thoracolumbar fracture patients without neurological symptoms in our department were enrolled in the research. 46 patients were treated with minimally invasive percutaneous pedicle screw fixation and 40 cases with the traditional open pedicle screw fixation. The perioperative index, periand postoperative radiography, relief of the low back pain and general health status of each group were documented and compared, respectively. Results： All patients have been followed up for 18 to 44 months, 32 months on the average. There were significant differences in the incision size, surgical blood loss, surgical draining loss, hospital stay and complications （P 〈 0. 05 ）, however, no difference in the surgical time was found. The Cobb angle, sagittal index, and anterior height of the fracture vertebral body were all significantly different between pre-operation and post-operation in each group （ P 〈 0. 05 ）. There was no significant difference in postoperative improvement of Cobb angle, sagittal index, anterior height of the fracture vertebral body in the two groups （ P 〉 0.05 ）. There was also no significant difference in the loss of the correction at mid-term follow-up （P 〉 0. 05 ）. VAS of back painwas improved obviously in percutaneous group compared with the open group after the operation, but there was no difference between the two groups one year later. Conclusions： Minimally invasive percutaneous pedicle screw fixation, which provides quicker recovery and shorter hospital stay, is an effective method to treat thoracolumbar fracture. This procedure is simpler, safer, less complication and blood loss than open operation.