不同手术方案在无神经损伤椎体骨折患者中的应用

Comparison of different surgical procedures in patients with vertebral fracture without nerve injury

目的比较经皮椎弓根螺钉内固定术和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的临床疗效。方法选取2013年1月至2015年5月于我院接受治疗的98例无神经损伤椎体骨折患者为研究对象,按照随机数表法将患者分为对照组和观察组,每组49例。对照组行开放椎弓根螺钉内固定术治疗,观察组行经皮椎弓根螺钉内固定术治疗,比较两组患者的手术切口长度、手术时间、术中出血量、术后引流量、切口愈合时间;比较两组患者治疗后1个月、3个月、6个月疼痛视觉模拟评分(VAS);比较治疗后2周两组患者血清C-反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子(TNF)、血清肌酸激酶活性(CK)的水平;治疗3个月后对患者进行复查,比较两组患者的椎体前缘影像学高度、后凸Cobb角以及椎体矢状面指数。结果观察组和对照组患者的手术切口长度[(1.83±2.01)cm vs(8.67±1.54)cm]、手术时间[(1.12±0.33)h vs(2.31±0.82)h]、术中出血量[(114.6±20.8)m L vs(276.5±40.8)m L]、术后引流量[(78.3±18.8)m L vs(162.4±45.6)m L]、切口愈合时间[(7.3±2.2)d vs(15.4±4.1)d]比较,观察组均优于对照组,差异均有统计学意义(P<0.05);观察组患者治疗后1个月、3个月、6个月VAS评分分别为(3.01±0.78)分、(2.07±1.04)分、(1.97±0.93)分,均低于对照组的(6.82±1.47)分、(5.83±1.31)分、(3.87±1.07)分,差异均有统计学意义(P<0.05);治疗2周后观察组和对照组患者的血清CRP[(43.1±3.3)mg/L vs(50.3±1.7)mg/L]、IL-6含量[(3.87±0.83)ng/L vs(5.24±0.98)ng/L]、TNF[(178.65±21.44)ng/L vs(193.52±18.76)ng/L]、CK[(54.1±11.1)IU/L vs(74.4±13.6)IU/L]比较,观察组优于对照组,差异均有统计学意义(P<0.05);治疗3个月后观察组和对照组患者椎体前缘影像学高度[(84.3±7.2)%vs(85.1±6.8)%]、后凸Cobb角[(8.23±2.97)°vs(8.27±3.01)°]、椎体矢状面指数[(90.8±15.4)%vs(91.2±14.7)%]比较,差异均无统计学意义(P>0.05)。结论经皮椎弓根螺钉内固定术与开放椎弓根螺钉内定术治疗无神经损伤椎体骨折患者的治疗效果相当,但经皮椎弓根螺钉内固定术手术时间短、愈合时间快且术后炎症反应水平更低,值得临床推广。

Objective To study the effect of percutaneous pedicle screw fixation and open pedicle screw fixation for the treatment of vertebral fractures without neural injury. Methods Ninety-eight patients with vertebral fracture without nerve injury in our hospital from January 2013 to May 2015 were selected. According to the random number table, the patients were divided into control group and observation group, with 49 patients in each group. The control group was treated with open pedicle screw fixation, and the observation group was treated with percutaneous pedicle screw fixation. The operation incision length, operation time, blood loss, postoperative drainage volume, and incision healing time were compared between the two groups. The pain Visual Analogue Scale（VAS） was compared between the two groups 1 month, 3 months and 6 months after treatment. The levels of serum C-reactive protein, interleukin-6,tumor necrosis factor, and serum creatine kinase activity were compared between the two groups 2 weeks after treatment. After 3 months of treatment, the patients were reviewed and compared in anterior vertebral height, Cobb angle and sagittal index. Results The incision length, operation time, intraoperative blood loss, postoperative drainage volume, incision healing time in the observation group vs the control group was（1.83±2.01） cm vs（8.67±1.54） cm,（1.12±0.33） h vs（2.31±0.82） h,（114.6±20.8） m L vs（276.5±40.8） m L,（78.3±18.8） m L vs（162.4±45.6） m L,（7.3±2.2） days vs（15.4 ± 4.1） days, respectively, all with statistically significant differences（P〈0.05）. The VAS scores of the observation group were（3.01±0.78）,（2.07±1.04）,（1.97±0.93） at 1 month, 3 months and 6 months after treatment respectively, which were lower than the corresponding（6.82±1.47）,（5.83±1.31）,（3.87±1.07） in the control group（P〈0.05）. The serum levels of CRP, IL-6, TNF, CK were（43.1 ± 3.3） mg/L,（3.87 ± 0.83） ng/L,（178.65 ± 21.44） ng/L,（54.1 ± 11.1） IU/L, which were significantly better than（50.3±1.7） mg/L,（5.24±0.98） ng/L,（193.52±18.76） ng/L,（74.4±13.6） IU/L in the control group（P〈0.05）. After 3 months of treatment, anterior vertebral height, Cobb angle, sagittal index in the observation group vs control group were（84.3±7.2）% vs（85.1±6.8）%,（8.23±2.97）° vs（8.27±3.01）°,（90.8±15.4）% vs（91.2±14.7）%respectively, all with no statistically significant difference between the two groups（P〉0.05）. Conclusion Percutaneous pedicle screw fixation and open pedicle screw fixation has the same therapeutic effect for the patients with vertebral fracture. However, percutaneous pedicle screw fixation has shorter operative time, shorter healing time and lower inflammatory reaction level, which is worth to be widely used in clinic.