微创经皮椎弓根螺钉内固定治疗不稳定性胸腰椎骨折的临床研究

Clinical observation of minimally invasive percutaneous pedicle screw fixation in the treatment of unstable thoracolumbar fractures

目的研究微创经皮椎弓根螺钉内固定(MIPPSF)治疗不稳定性胸腰椎骨折(UTF)的临床效果。方法选取该院2013年1月至2016年6月手术治疗的UTF患者88例,采用随机数字表法分为MIPPSF组和开放组,每组44例。MIPPSF组行MIPPSF治疗,开放组行常规开放椎弓根螺钉内固定治疗,观察两组患者手术时间、术中出血量、术后下床时间、住院时间,以及术前,术后7、90、180 d病锥后凸Cobb′s角、病锥高度,术后螺钉位置分级,术后并发症发生情况等。结果 MIPPSF组患者手术时间、术中出血量、术后下床时间、住院时间均明显优于开放组,差异均有统计学意义(P<0.05)。两组患者术后7、90、180 d病锥后凸Cobb′s角均较术前明显减小,病锥高度均较术前明显增加,差异均有统计学意义(P<0.05);两组患者术后7、90、180 d病锥后凸Cobb′s角、病锥高度比较,差异均无统计学意义(P>0.05)。两组患者术后螺钉位置分级均为0级,差异无统计学意义(χ2=0.000 0,P=1.000 0)。两组患者术后并发症发生率比较,差异无统计学意义(χ2=2.046 5,P=0.152 6)。结论 MIPPSF治疗UTF创伤小,恢复快,疗效等同于常规开放椎弓根螺钉内固定治疗。

Objective To explore the clinical effect of minimally invasive percutaneous pedicle screw fixation（MIPPSF） in the treatment of unstable thoracolumbar fractures（UTF）. Methods Totally 88 patients undergone surgery with ITF from January 2013 to June 2016 in our hospital were divided into MIPPSF group（n=44） and open group（n=44） according to the random number table. The MIPPSF group was treated with MIPPSF while the open group was treated with conventional open percutaneous pedicle screw fixation. The operation time intraoperative blood loss,time out of bed and hospital stay after surgery,preoperative and postoperative 7,90,180 d Cobb′s angle of kyphosis,cone height,postoperative screw position classification,postoperative complications etc. were observed and compared. Results The operation time,intraoperative blood loss,time out of bed and hospital stay after surgery of the MIPPSF group were less than those of the open group with statistically significant（P0.05）.Compared with the indicators before operation,the 7,90,180 d Cobb′ s angle of kyphosis increased while the cone height decreased,the difference was statistically significant（P0.05） There were no significant statistical difference（P0.05）between the two groups concerning the postoperative 7,90,180 d Cobb′s angle of kyphosis and cone height. The postoperative screw position classification of the two groups were grade 0,and there were no statistically significant difference（ χ~2=0.000 0,P=1.000 0）. There was no statistically significant difference between the two groups in postoperative complication rate s（ χ~2=2.046 5,P=0.152 6）.Conclusion MIPPSF has the advantages of recovering quickly with minimal trauma in the treatment of UTF,and the clinical efficacy is similar to conventional open percutaneous pedicle screw fixation.