经皮微创与椎旁肌间隙入路椎弓根螺钉内固定治疗胸腰椎骨折疗效分析

Screw fixation of minimally invasive percutaneous and paraspinal muscle space approach for the treatment of thoracolumbar fractures

目的比较经皮微创椎弓根螺钉内固定和后路椎旁肌间隙行椎弓根螺钉内固定治疗胸腰椎骨折的临床疗效。方法回顾性分析2013年3月至2015年10月29例采用经皮微创椎弓根螺钉内固定治疗(微创组)和28例采用后路椎旁肌间隙行椎弓根螺钉内固定治疗(肌间隙组)胸腰椎骨折患者的临床资料,比较2组患者手术前后伤椎椎体前缘高度比、矢状面Cobb角、手术切口、手术时间、透视次数、术中出血量以及ODI和VAS评分。结果随访2组患者6~18个月,平均12.6个月。2组患者术后3 d、3个月、1年伤椎矢状面指数及Cobb角均获得良好恢复,与术前相比差异具有统计学意义(P<0.05);2组患者术后1周、3个月、1年的ODI和VAS评分较术前均明显降低,2组患者比较无明显差异(P>0.05)。微创组患者手术创伤和术中出血量明显低于肌间隙组,而手术时间和透视次数明显多于肌间隙组,差异有统计学意义(P<0.05)。结论经皮微创椎弓根螺钉内固定与肌间隙椎弓根螺钉内固定治疗胸腰椎骨折均有确切疗效,安全可靠,肌间隙椎弓根螺钉内固定术手术时间更短,操作更为简便;经皮微创椎弓根螺钉内固定术创伤小、出血少,术后恢复快。

Objective To compare the clinical efficacy of minimally invasive percutaneous pedicle screw fixation and posterior paraspi- nal muscle space approach pedicle screw fixation for the treatment of thoracolumbar fractures. Methods Retrospectively analyzed the clinical data of 29 patients treated via minimally invasive percutaneous pediele screw fixation（ minimally invasive group） and 28 patients treated via posterior paraspinal muscle space approach pedicle screw fixation（ paraspinal nmsele approach group） from March 2013 to October 2015. The anterior vertebral height ratio, sagittal Cobb angle, surgical incision, operation time, number of fluoroscopy, intraoperative blood loss and ODI and VAS scores were compared between the two groups. Results All patients were followed up for an average period of 12.6 months （ ranged from 6 to 18 months）. At the end of 3 days,3 months and 12 months after operation, vertebral sagittal index and Cobb angle of the two groups were significantly recovered compared with the preoperative data（ P 〈 0.05 ） , and the ODI and VAS scores were significantly lower than those before the operation, but the above indicators had no significant difference between the two groups（ P 〉 0.05 ）. The surgical trauma and intrao- perative blood loss of patients in the minimally invasive group were significantly lower than those of the paraspinal muscle approach group, while the operation time and fluoroscopy times were significantly higher than those of the paraspinal muscle approach group, and the differ- ences were statistically significant（ P 〈 0.05 ）. Conclusion Minimally invasive pereutaneous and paraspinal muscle approach pediele screw fixation are both effective, safe and reliable. Paraspinal muscle approach pediele screw fixation has shorter operation time and easier opera- tion, while minimally invasive pereutaneous pediele screw fixation has less trauma,less bleeding and faster postoperative recovery.