经皮与开放椎弓根螺钉内固定治疗单节段无神经症状胸腰椎骨折的临床对比研究

A contrast clinical study of percutaneous and open pedicle screw internal fixation of single segment thoracolumbar fractures without neurologic symptoms

目的对比分析经皮与开放椎弓根螺钉内固定治疗单节段无神经症状胸腰椎骨折的临床疗效。方法 2011年1月至2014年1月,我院对经皮微创椎弓根螺钉内固定58例患者与同期44例开放手术患者临床资料进行比较和随访分析,研究围手术期相关指标、影像学指标、视觉模拟疼痛评分(visual analog scale,VAS)、Oswestry功能障碍指数(oswestry disability index,ODI)、中远期疗效等指标。结果微创组手术切口长度平均(6.6±0.8)cm,术中出血量平均(55±27.6)ml,住院时间平均(7.9±2.6)天,下床时间平均(4.3±1.7)天,开放组手术切口长度平均(15.1±2.7)cm,术中出血量平均(213±54.5)ml,住院时间平均(16±5.2)天,下床时间平均(10.5±3.2)天,微创组明显优于开放组,差异有统计学意义(P<0.05),而手术时间、置钉准确率、椎体高度的恢复、术后6个月、1年的ODI指数差异无统计学意义(P>0.05)。结论经皮椎弓根螺钉内固定是治疗单节段无神经症状胸腰椎骨折的理想微创方法,具有创伤小,恢复快,疗效确切等优点,中远期疗效与开放性手术相似。

Objective To compare and analyze clinical outcomes of percutaneous and open pedicle screw internal ifxation of single segment thoracolumbar fractures without neurologic symptoms.Methods One hundred and two patients with thoracolumbar fractures without neurologic symptoms underwent either percutaneous pedicle screw ifxation （ PF,n=58 ） or open pedicle screw ifxation （ OF,n=44 ） between January 2011 and January 2014. Perioperative related indicators, radiographs indicators, visual analog scales （ VAS ）, oswestry dysfunction index （ ODI ）, middle and long-term efifcacy were analyzed.Results PF group： incision length （ mean, 6.6±0.8 cm ）, blood loss （ mean, 55± 27.6 ml ）, hospital stay （ mean, 7.9±2.6 days ）, getting out-of-bed time （ mean, 4.3±1.7 days ）. OF group： incision length （ mean, 15.1±2.7 cm ）, blood loss （ mean, 213±54.5 ml ）, hospital stay （ mean, 16±5.2 days ）, getting out-of-bed time （ mean, 10.5±3.2 days ）. There were signiifcant differences in 2 groups （P〈0.05 ）. PF results were superior to OF group. No signiifcant differences existed in operation time, screw accuracy, recovery of vertebral body height and ODI 6 months, 12 months postoperatively in 2 groups （P〉0.05 ）.Conclusions Percutaneous pedicle screw internal ifxation as a good minimally invasive surgery method has the advantages of small trauma, earlier recovery and confirmed efifcacy. Clinical outcomes in middle and long-term of PF are similar with OF.