经皮与开放椎弓根螺钉内固定术治疗无神经损伤胸腰段骨折对比研究

Comparative study of percutaneous and open pedicle screw fixation for thoracolumbar fractures without neurological injury

目的探讨经皮与开放椎弓根螺钉内固定术治疗无神经损伤胸腰段骨折的效果。方法选取2013年7月至2015年5月72例无神经损伤胸腰段骨折患者，根据手术方式不同分为研究组与对照组，每组36例。对照组行开放椎弓根螺钉内固定术，研究组行经皮椎弓根螺钉内固定术。对比两组手术情况、伤椎高度及Cobb角恢复与丢失情况、手术前后两组腰痛程度评分及日常生活活动能力评分、MRI炎性区域体积变化情况，并统计两组并发症发生率。结果研究组手术用时、术中出血量、下床活动时间及住院时间均明显优于对照组，差异有统计学意义（P〈0．05）；两组伤椎高度及Cobb角恢复值（率）与丢失值（率）对比差异均未见统计学意义（P〉0．05）；术前两组VAS及Barthel指数评分对比差异未见统计学意义（P〉0．05），经治疗，两组各指标评分均较术前改善（P〈0．05）；术前两组MRI炎性区域体积对比差异未见统计学意义（P〉0．05），经治疗，研究组优于对照组，差异有统计学意义（P〈0．05）；两组并发症发生率均为2．78％，差异未见统计学意义（P〉0．05）。结论采用经皮与开放椎弓根螺钉内固定术治疗无神经损伤胸腰段骨折患者均对提高患者生活活动能力、缓解疼痛具有重要意义，但经皮椎弓根螺钉内固定术手术相关指标优于开放椎弓根螺钉内固定术，且引起的局部炎性反应较轻，具有推广价值。

Objective To study the effect of percutaneous and open pedicle screw fixation on thoracolumbar fractures without neurological injury. Methods From July 2013 to May 2015, 72 thoraeolumbar fractures without neurological injury patients were selected. According to the different surgical methods, they were divided into study group and control group, with 36 cases in each group. Open pedicle screw fixation was performed in the control group, and the study group was treated by percutaneous pediele screw internal fixation. The operation condition, injury vertebral height and Cobb angle of recovery and loss, the degree of low back pain score and ability of activities of daily living score before and after operation, MRI inflammation regional volume change situation in the two groups were compared, and the complications of the two groups were observed. Results In the study group, the amount of bleeding, time of operation and hospitalization time were better than those in the control group, the differences were significant （P 〈 0. 05 ）. There was no significant difference between the two groups in injured vertebral height or Cobb angle recovery （rate）, lost value （rate） （P 〉 0. 05 ）. There was no significant difference between the two groups in VAS or Barthel index score （P 〉 0. 05）. After treatment, the scores of each index of the two groups significantly improved （P 〈0. 05）. There was no significant difference in the volume of MRI inflammatory regions between the two groups （P 〉 0. 05）. After treatment, the volume of MRI inflammatory regions in the study group was better than that in the control group, the difference was significant （P 〈 0. 05）. The incidence of complications in the two groups was both 2. 78% （P 〉 0. 05 ）. Conclusions The percutaneous and open pedicle screw fixation treatment in treatment of patients without nerve injury of thoracolumbar fracture can improve the living ability, relieve pain, and has important significance.