经皮椎弓根螺钉和开放手术治疗胸腰段骨折早期疗效比较

Comparison of the early curative effect of percutaneous pedicle screw fixation and conventional open surgery for thoracolumbar fractures

目的:比较微创经皮椎弓根螺钉和传统切开内固定手术方案治疗胸腰段骨折的早期临床疗效。方法:选取我院2014年1月~2015年6月收治的无神经损伤胸腰段骨折患者35例。按手术方案不同分为微创组和开放组。微创组接受经皮椎弓根螺钉内固定手术方案;开放组接受传统切开复位椎弓根螺钉内固定方案。结果:微创组在手术时间、术中出血量和住院时间等指标上优于开放组,差异有统计学意义(P<0.01)。微创组末次随访VAS比术前降低,差异有统计学意义(P<0.01)。开放组末次随访VAS值低于术前,差异有统计学意义(P<0.01)。两组患者术后随访测量伤椎高度均较术前有较大改善,差异有统计学意义(P<0.01)。两组术前与术后影像学比较,矢状位后凸Cobb角、矢状位指数均有差异(P<0.05)。结论:微创经皮椎弓根螺钉内固定手术和传统开放手术治疗胸腰段椎体骨折均安全有效,值得临床上推广应用。

Objective： To compare the early curative effect of percutaneous pedicle screw fixation and conventional open surgery in the treatment of thoracolumbar fractures.Methods： Thirty-five cases of thoracolumbar fractures free of neurological involvement,admitted to and treated in our hospital between January 2014 and June 2015,were included,and divided into minimally invasive group and open group by the surgical options.Patients in the minimally invasive group were treated with percutaneous pedicle screw fixation,and those in the open group,with conventional open reduction and internal fixation with pedicle screw fixation.Results： Patients in the minimally invasive surgery group had significantly shortened operative time,lower intraoperative blood loss,and reduced hospital stay than the control group（ P〈0.01）.VAS scoring was significantly lower at the final follow-up than that before operation in the two groups（ P〈0.01）,and postoperative follow-up indicated greater improvement of the height of the injured vertebrae（ P〈0.01）. Comparison of the imaging findings before and after surgery showed significantly improved posterior convex angle and sagittal index（ P〈0.05）. Conclusion： Both minimally invasive percutaneous pedicle screw internal fixation and conventional open surgery can be safe and effective in the treatment of thoracolumbar vertebral fractures,and is worthy of wider clinical recommendation.