经皮微创与开放手术治疗胸腰椎骨折的疗效对比观察

Comparative study of clinical efficacy of minimally invasive percutaneous and open surgical treatment on thoracolumbar fractures

目的：对比研究经皮微创手术和传统开放手术治疗胸腰椎骨折的临床疗效。方法：自2011年9月~2013年9月治疗38例新鲜胸腰椎骨折患者,其中18例行经皮微创手术,20例行传统开放手术,比较围手术期参数、影像学指标、术后半年腰背部疼痛评分（VAS评分）及腰背残障功能指数（ODI）。结果：两组比较围手术期参数、VAS评分及ODI均有统计学意义（P〈0.05）,经皮微创组明显低于开放手术组;两组分别比较术前、术后影像学指标如椎体前缘高度、后凸Cobb＇s角、椎间隙高度及椎管堵塞指数,差异有统计学意义（P〈0.05）;但两组之间术后影像学指标及骨折愈合时间对比,差异无统计学意义（P〉0.05）。结论：经皮椎弓根微创手术治疗胸腰椎骨折具有手术时间短、创伤小,对椎旁肌损伤小,恢复快,术后疼痛轻等优点,同时达到了传统开放手术的效果,值得临床推广应用。

Objective： To compare the clinical efficacy of percutaneous minimally invasive surgery and traditional open surgery on the treatment of thoracolumbar fractures. Methods： Among 38 cases of fresh thoracolumbar fractures from September 2011 to September 2013, 18 cases underwent percutaneous minimally invasive surgery, and 20 cases traditional open surgery. The perioperative parameters, radiographic index,postoperative half-year back pain score（VAS）, and functional disability index back（ODI） were all compared.Results： The perioperative parameters, postoperative pain score（VAS）, and low back disability function index（ODI） in the percutaneous minimally invasive group were significantly lower than that of the open surgery group（P〈0.05）. There were significant differences between the radiographic indicators pre and post operative such as anterior vertebral height, kyphosis Cobb＇s angle, inervertebral height, and spinal blockage index contrast（P〈0.05）, but the postoperative radiographic index and the time of fracture healing had no significant differences（P〉0.05）. Conclusion： Percutaneous minimally invasive surgery can achieve the effect of the traditional open operation with shorter operative time, less trauma, less damage to the paraspinal muscles, faster recovery and milder postoperative pain. Therefore, it is well worth applicating in the treatment of thoracolumbar fractures.