微创与开放方案置入椎弓根螺钉内固定修复胸腰椎骨折对疗效指标及预后的影响

Effect of minimally invasive versus open pedicle screw fixation on the curative effect and prognosis for repair of thoracolumbar vertebral fracture

目的探讨微创与开放方案置入椎弓根螺钉内固定修复胸腰椎骨折对疗效指标及预后的影响。方法回顾性分析2013年1月-2014年12月诊治的120例胸腰椎骨折患者资料,按照不同治疗方式分为三组,对照组43例行开放内固定治疗;研究A组38例行Quadrant通道内固定治疗;研究B组39例行经皮Sextant内固定治疗。对比三组围术期手术时间、切口长度、术中出血量等;伤椎前缘高度、后凸Cobb角、矢状位指数等及预后。结果研究A、B组围术期手术时间、切口长度、出血量、引流量、下地时间、住院时间均优于对照组（P〈0.01）,研究B组在切口长度、出血量及下地时间均优于研究A组（P〈0.01）;三组治疗6个月后疗效指标均较治疗前改善,其中研究B组Oswestry功能障碍指数改善幅度较对照组、研究A组大（P〈0.05）,三组不良事件发生率差异无统计学意义（P=0.367）。结论微创方案置入椎弓根螺钉内固定修复胸腰椎骨折疗效显著且预后佳。

Objective To explore the effect of minimally invasive and open pedicle screw fixation on the curative effect and prognosis for the repair of thoracolumbar vertebral fractures. Methods The clinical data of 120 patients who had received treatment for repair of thoracolumbar vertebral fractures in our hospital between Jan. 2013 and Dec. 2014 was reviewed. They were divided into three groups according to different treatments,with 43 patients given open fixation as the control group,38 cases given Quadrant fixation as study groups A and 39 cases given percutaneous Sextant fixation as study group B. Perioperative indicators as operation time,incision length,operative blood loss,efficacy indicators and prognosis of the three groups were compared. Results The perioperative time,incision length,blood loss,drainage,ambulation time,hospital stay in study group A and B were all better than those of the control group（ P〈0. 01）,and study group B was better than study group A in terms of incision length,bleeding volume and time for ambulation（ P〈0. 01）. After 6 months of treatment,the efficacy indicators in the three groups were improved,and the improvement of Oswestry Disability Index was more significant in study group B compared with that in the control group and study group A（ P〈0. 05）. Difference in the incidence of adverse events among the three groups was not statistically significant（ P = 0. 367）. Conclusion Minimally invasive pedicle screw fixation has significant effect and satisfactory prognosis for the repair of thoracolumbar vertebral fractures.