微创经肌间隙入路椎弓根螺钉固定手术治疗胸腰椎骨折的效果评价

Effect of Minimally invasive trans-muscular pedicle screw fixation in treatment of thoracolumbar fractures

目的探讨微创经肌间隙入路椎弓根螺钉固定手术治疗胸腰椎骨折的治疗效果。方法选择2012年3月—2015年3月在浙江省湖州市中心医院骨科胸腰椎骨折进行经肌间隙入路椎弓根螺钉固定手术治疗的患者50例作为微创手术组,选择同期胸腰椎骨折进行传统切开手术治疗的患者50例作为传统切开组。比较微创手术组和传统切开组患者的临床资料、围手术期情况、手术前后影像学情况以及手术前后功能障碍指数评分情况。结果微创手术组的年龄、性别和胸腰椎损伤部位和传统手术组比较差异无统计学意义(P>0.05),微创手术组的出血量和引流量明显低于传统切开组(P<0.05),微创手术组的手术时间和住院时间明显低于传统切开组(P<0.05)。2组术后伤锥前缘高度均明显高于术前伤锥前缘高度(P<0.05),2组术后伤椎后凸角θ和Cobb角θ均明显低于术前(P<0.05)。2组术后6个月功能障碍指数评分均明显低于术前功能障碍指数评分(P<0.05)。结论微创手术和传统手术对胸腰椎骨折均有良好的治疗效果,均可改善患者的功能障碍,微创手术治疗比传统切开手术治疗损伤小、出血少、住院时间短、术后恢复快。

Objectives To investigate theefficacy ofminimally invasive trans-muscular pedicle screw fixation in the treatment thoracolumbar fractures. Methods The clinical data of 50 cases of thoracolumbar fractures undergoing minimally invasive trans-muscular pedicle screw fixation and 50 cases undergoing traditional surgery surgery in the same period I our hospital between March,2012 and March ,2015 were reviewed. Theclinical data,perioperativesituation, imaging and Disability Index score before after the surgery were compared between the two groups. Results The age, gender and thoracolumbar injury site were not significant differences between the two groups （P 〉 0.05 ）, the bleeding amount and drainage of minimally invasive surgery group was significantly lower than that of traditional surgery group （ P 〈 0.05 ）, the operation time and hospital stay of minimally invasive surgery group were significantly lower than that of traditional incision group （ P 〈 0.05 ）. The anterior height ofthe involved cone was higher than before in both groups （ P 〈 0.05 ）. Thevertebral kyphosis angle and Cobb angle after the operation in both groups were lower than before （ P 〈 0.05 ）. The dysfunction index scores within six months after the surgery in both groups were significantly lower than before （ P 〈 0.05 ）. Conclusion Both minimally invasive surgery and traditional surgery for thoracolumbar fractures have good therapeutic effect, they can improve the functional disorders of patients. The minimally invasive surgical treatment have less damage, lessbleeding, shorter hospital stay and recovery quick than traditional incision treatment.