小切口普通椎弓根螺钉内固定治疗无神经损伤胸腰段骨折的疗效分析

Curative effect of mini-incision common vertebral pedicle screw internal fixation on thoracoclumbar fractures without neurological injury

目的探讨小切口普通椎弓根螺钉内固定治疗无神经损伤胸腰段骨折的早期临床疗效。方法回顾性收集2014年2月—2016年1月采用小切口普通椎弓根螺钉或经皮空心椎弓根螺钉内固定治疗61例无神经损伤胸腰段骨折患者临床资料,其中小切口固定32例(小切口组),经皮固定29例(经皮组)。对两组患者手术切口总长度、手术时间、术中出血量、术中透视次数、术后卧床时间、住院费用等围手术期指标,以及手术前后疼痛视觉模拟评分(Visual Analogue Scale,VAS)、Oswestry功能障碍指数(Oswestry Disability Index,ODI)、伤椎Cobb角矫正度、术后螺钉位置准确率等进行比较分析。结果所有患者均获随访,随访时间6~24个月,平均13.4个月。经皮组1例发生2枚螺钉断裂,两组均无切口感染及神经血管损伤等并发症发生。小切口组与经皮组手术切口总长度分别为(7.33±0.53)、(6.38±0.44)cm,手术时间分别为(62.66±4.75)、(72.93±5.09)min,透视次数分别为(5.63±0.61)、(19.07±1.60)次,住院费用分别为(2.33±0.15)万元、(3.95±0.16)万元,差异均有统计学意义(P<0.001)。两组术中出血量、术后卧床时间、VAS及ODI评分、伤椎Cobb角矫正度、螺钉位置准确率比较差异均无统计学意义(P>0.05)。结论小切口普通椎弓根螺钉内固定治疗无神经损伤胸腰段骨折,手术时间短,术中透视少,住院费用低,固定强度大,早期临床疗效满意。

Objective To explore the short-term therapeutic effect of mini-incision common vertebral pedicle screw internal fixation on thoracoclumbar fractures without neurological injury. Methods The data of 61 patients with thoracolumbar fractures without neurological injury treated with mini-incision common vertebral pedicle screw internal fixation （the mini-incision group, n=32） or percutaneous pedicle screw fixation （the percutaneous group, n=29） from February 2014 to January 2016 was retrospectively collected and analyzed. Total incision length, operation time, blood loss, fluoroscopy times, postoperative bed rest time, hospitalization costs, Visual Analogue Scale （VAS） score, Oswestry Disability Index （ODI）, vertebral Cobb angle of correction, and accuracy rate of screw placement were compared between the two groups. Results All the patients were followed up for 6 to 24 months with a mean of 13.4 months. There were no complications such as incision infection and neurovascular injury except for 2 screws breakage in one patient in the percutaneous group. In the mini-incision group, the average total incision length was longer than that in the percutaneous group [（7.33±0.53） vs. （6.38±0.44） cm], while the average operation time was shorter than that in the percutaneous group [（62.66±4.75） vs. （72.93±5.09） minutes]; the differences were statistically significant （P〈0.001）. In the mini-incision group, the average frequency of fluoroscopy was fewer [（5.63±0.61）vs. （19.07±1.60） times] and the average hospitalization costs was lower [（23.3±1.5） thousand yuan vs. （39.5±1.6） thousand yuan] than those in the than that in the percutaneous group; the differences were statistically significant （P〈0.001）. No significant difference was found in blood loss, postoperative bed rest time, VAS score, ODI, vertebral Cobb angle of correction, and accuracy rate of screw placement between the two groups （P〉0.05）. Conclusions Mini-incision common vertebral pedicle screw internal fixation for thoracoclumbar fractures without neurological injury has the advantages of short operation time, less fluoroscopy times, low hospitalization costs and high fixation strength. It may obtain a good short-term effectiveness.