经皮单平面椎弓根螺钉与开放椎弓根螺钉治疗胸腰椎骨折疗效比较

The efficacy comparison of percutaneous monoaxial screw and open treatment for treatment of thoracolumbar fractures with pedicle screw system

目的：比较经皮单平面椎弓根螺钉与开放椎弓根螺钉内固定治疗单节段胸腰椎骨折的中期临床疗效。方法将76例胸腰椎骨折患者按治疗方法分为两组：42例采用经皮单平面椎弓根螺钉联合伤椎置万向钉治疗（经皮单平面组），34例采用传统后路开放式椎弓根螺钉固定术治疗（传统开放组）。比较两组围手术期相关指标、中期随访时影像学指标及腰背部疼痛改善情况。结果患者均获得随访，时间20～44个月。术中出血量、切口长度经皮单平面组均优于传统开放组，差异均有统计学意义（ P＜0.05）。后凸Cobb角、矢状面指数、伤椎椎体前缘高度两组术后及末次随访与术前比较差异均有统计学意义（P＜0.05），两组间比较差异均无统计学意义（P＞0.05）。疼痛缓解术后3 d经皮单平面组较传统开放组更明显（P＜0.05），末次随访时两组差异无统计学意义（ P＞0.05）。结论经皮单平面椎弓根螺钉固定治疗胸腰椎骨折疗效与传统开放手术相当，且创伤小。

Objective To compare the mid term clinical efficacy between minimally invasive percutaneous monoaxial pedicle screw fixation and traditional open pedicle screw fixation in the treatment of thoracolumbar fracture .Methods Seventy-six patients with thoracolumbar fractures were divided into two groups according to treatment methods .For-ty-two patients were treated by minimally invasive percutaneous monoaxial pedicle screw fixation combined with in -jured vertebral screw fixation .In the other group , a total of 34 patients of thoracolumbar fractures were treated in open surgery by implanting polyaxial screw in the injured vertebra , and fixed screws were put into vertebraes superior and inferior to the injured vertebra .The perioperative related indexes of two groups were compared , and the radiographic parameters and the improvement of pain in the waist and back were compared .Results All patients were followed up for 20~44 months.There were significant differences in the volume of bleeding ,length of incision （P〈0.05）,and There were significant differences in the Cobb angle , sagittal index , and injured vertebral anterior height which were compared in preoperative and postoperative image （ P〈0.05 ） .There were significant differences which were com-pared in preoperative and the last follow-up （P〈0.05）.There was no statistically significant difference between the two groups at the same time（P〉0.05）.The pain relief was more obvious than the traditional open group ,3 days after surgery（P〈0.05）; at the last follow-up, there was no significant difference between the two groups （P〉0.05）. Conclusions The clinical efficacy of percutaneous monoaxial screw fixation in the treatment of thoracolumbar frac -tures is comparable with the traditional open surgery , and less trauma .