微创经皮椎弓根螺钉内固定术治疗无神经症状的单节段胸腰椎骨折

Clinical study on the application of minimally invasive percutaneous pedicle screw fixation in single segment thoracolumbar fracture without neurological symptoms

目的探讨微创经皮椎弓根螺钉内固定术治疗无神经症状的单节段胸腰椎骨折的临床效果。方法分别采用开放式椎弓根螺钉内固定术(16例)和微创经皮椎弓根螺钉内固定术(22例)治疗38例无神经症状的单节段胸腰椎骨折患者,记录手术切口长度、手术时间、术中出血量、术后引流量和术后并发症,胸腰椎正侧位和过伸过屈位X线测量手术前后矢状位Cobb角和伤椎前缘高度,改良Macnab标准评价手术疗效。结果 38例患者手术成功率达100%,手术融合114个椎体节段,共植入228枚椎弓根螺钉。与开放式手术组相比,微创经皮手术组患者手术切口长度缩短[(10.55±1.23)cm对(18.50±2.50)cm,P=0.000]、术中出血量减少[(32.55±7.22)ml对(320.50±15.48)ml,P=0.000]、住院时间缩短[(6.55±1.50)d对(13.50±2.52)d,P=0.000],且无需引流。术后平均随访(4.65±1.24)个月,术后3个月时两组患者矢状位Cobb角较术前减小(P=0.000)、伤椎前缘高度较术前增加(P=0.000);开放式手术组总显效率为14/16,微创经皮手术组为86.36%(19/22),组间差异无统计学意义(P=1.000)。结论微创经皮椎弓根螺钉内固定术治疗胸腰椎骨折具有手术创伤小、术中出血量少、恢复迅速等优点,近期疗效与开放式手术相似,但远期疗效尚待进一步研究。

Objective To discuss the clinical effects of minimally invasive percutaneous pedicle screw fixation in the treatment of single segment thoracolumbar fracture without neurological symptoms. Methods From June 2012 to October 2014, 38 neurologically intact patients with thoracolumbar fracture underwent surgeries, including open pedicle screw fixation in 16 cases and percutaneous pediele screw fixation in 22 cases. The incision length, operation time, intraoperative blood loss, postoperative drainage and posloperative complication were recorded and compared between 2 groups. Thoracolumbar orthophoric, lateral and flexion-extension X-ray was used to measure sagittal Cobb angle and height of injured anterior vertebral body before and after operation. Modified Macnab evaluation was used to assess the curative effects 3 months after operation. Results The success rate of operations in 38 patients was 100%. There were a total of 114 vertebral bodies fused and 228 pedicle screws implanted. Patients in the percutaneous pedicle screw group had smaller incision length [（10.55±1.23） cm vs （18.50 ±2.50） era, P = 0.000], less intraoperative blood loss [（32.55 ± 7.22） ml vs （320.50 ± 15.48） ml, P = 0.000], shorter hospital stay [（6.55 ± 1.50） d vs （13.50 ± 2.52） d, P = 0.000], and without postoperative drainage. The follow-up after operation ranged from 3 to 6 months, with the average time of （4.65 -＋ 1.24） months. Cobb angle was reduced （P = 0.000） and height of injured anterior vertebral body were improved signifcantly （P = 0.000） 3 months after surgery in both groups. The total effective rate was 14/16 in open surgery group, and 86.36% （19/22） in percutaneous pedicle screw group, however, the difference between 2 groups was not significant （P = 1.000）. Conclusions Minimally invasive percutaneous pedicle screw fixation is a surgical method with less iatrogenic injury, less intraoperative blood loss and quick recovery for patients with thoracolumbar fracture. The short-term effect of percutaneous surgery is similar to open surgery, however, its long-term effect remains to be further studied.