HXN型微创椎弓根螺钉系统经伤椎固定治疗胸腰椎骨折

Vertebral fixation with minimally invasive HXN pedicle screw system for thoracolumbar fractures

背景:临床上脊柱后路切开复位内固定术治疗胸腰椎骨折已使用多年,疗效肯定,但手术创伤大,并发症多,Wiltse入路复位椎弓根钉内固定及Sextant、Zina等经皮椎弓根钉系统亦存在切口大、固定强度不足、矫形力量有限等缺点。目的:探讨HXN型微创椎弓根钉系统经伤椎固定治疗胸腰椎骨折的手术效果。方法:将2014年10月至2016年12月新乡医学院第一附属医院骨科收治的68例胸腰椎骨折患者随机分成2组,微创组行HXN型微创椎弓根钉经伤椎置入内固定术,对照组行切开复位经伤椎置入内固定术。采用出血量等围手术期参数、目测类比评分、Oswestry功能障碍指数、伤椎前缘高度比值、Cobb角等指标对比2组疗效。结果与结论:(1)对患者进行3-24个月随访;(2)2组在手术时间、术中透视次数方面差异无显著性意义(P>0.05),对照组术中失血量多于微创组(P<0.05);(3)2组术前目测类比评分、Oswestry功能障碍指数差异无显著性意义(P>0.05);术后及末次随访时目测类比评分、Oswestry功能障碍指数均较术前降低(P<0.05),但微创组低于对照组(P<0.05);(4)2组术后伤椎前缘高度、Cobb角均较术前显著改善(P<0.05),末次随访时伤椎前缘高度、Cobb角无明显丢失(P>0.05),且末次随访时2组相比差异无显著性意义(P>0.05);(5)微创组术后切口愈合良好,对照组出现2例切口感染;随访期间2组均未见内固定松动、移位及断裂情况发生;(6)结果提示,HXN型微创椎弓根钉系统经伤椎固定治疗胸腰椎骨折不仅具有创伤小、出血少、切口感染率低、残余痛轻等优点,并且操作安全易行,术后内固定稳定性好,能够与开放手术达到相同的固定效果。

BACKGROUND： Open reduction and internal fixation have been used to treat thoracolumbar fractures, which possesses good efficacy, but causes large trauma and many complications. Minimally invasive treatment like Wiltse operative approach and Sextant, Zina system also has many defects such as large incision, insufficient fixed strength, limited orthopedic forces. OBJECTIVE： To access the effect of vertebral fixation with HXN pedicle screw system in the treatment of thoracolumbar fractures. METHODS： Totally 68 cases of thoracolumbar fractures admitted in the Department of Orthopedics, the First Affiliated Hospital of Xinxiang Medical University from October 2014 to December 2016 were randomly divided into two groups： the patients in group A received minimally invasive pedicle screw fixation with HXN system and those in group B were subjected to open reduction and internal fixation. The perioperative indexes （blood loss）, Visual Analogue Scale scores, Oswestry Disability Index, anterior vertebral height, and Cobb angle were detected to compare the curative efficacy between two RESULTS AND CONCLUSION： （1） All patients were followed up for 3-24 months. （2） There were no significant differences in the operation time, intraoperative fluoroscopy times between two groups （P 〉 0.05）, and the blood loss in the group B was significantly more than that in the group A （P 〈 0.05）. （3） The preoperative Visual Analogue Scale and Oswestry Disability Index scores showed no significant differences between two groups （P 〉 0.05）, and the postoperative and last follow-up scores were significantly decreased （P 〈 0.05）, but the group A had lower scores than those in the group B （P 〈 0.05）. （4） The anterior vertebral height and Cobb angle were significantly improved postoperatively （P 〈0.05）; at the last follow-up, both indexes had no obvious loss and showed no significant difference between two groups （P 〉 0.05）. （5） The incision healed well in the group A, while there were two cases of incision infection in the group B. No screw loosening, displacement or rupture occurred during follow-up. （6） These results suggest that the minimally invasive HXN pedicle screw system for thoracolumbar fracture not only has the advantages of fewer traumas, less blood loss, low incidence of incision infection, pain relief, but also is safe and easy to operate, which obtains good fixation stability and can achieve the same curative effect with the open surgery.