经皮椎弓根螺钉内固定术治疗胸腰椎骨折的临床研究

Clinical efficacy of percutaneous pedicle screw fixation in the treatment of thoracolumbar fractures

目的对比经皮椎弓根螺钉内固定术与传统后路椎弓根螺钉内固定术治疗胸腰椎骨折的临床疗效。方法选择石狮市(华侨)医院骨科于2015年6月至2016年7月收治的57例胸腰椎骨折患者为研究对象,根据随机数表法分为观察组(n=28)和对照组(n=29),对照组患者予后路椎弓根螺钉内固定术治疗,观察组患者采用经皮椎弓根螺钉内固定术治疗,比较两组患者的围手术期指标,随访1年,观察椎体影像学指标的变化。结果观察组患者的手术时间、出血量、术后离床时间及住院时间分别为(43.5±5.8)min、(80.6±25.4)m L、(7.5±2.4)d、(11.4±3.8)d,均明显少于对照组的(90.5±15.7)min、(230.7±55.9)m L、(13.4±4.3)d、(18.3±5.7)d,差异均有统计学意义(P<0.05);随访1年时,观察组患者的椎体前缘高度比值及后凸Cobb角分别为(85.4±17.6)%、(9.9±2.8)°,与对照组的(87.5±18.9)%、(9.1±3.2)°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治疗胸腰椎骨折具有确切的疗效,并且具有手术时间短、出血量少、术后恢复快等微创优势。

Objective To compare the clinical efficacy of percutaneous pedicle screw fixation and traditional posterior pedicle screw fixation in the treatment of thoracolumbar fractures. Methods A total of 57 cases of patients with thoracolumbar fracture, who admitted to Department of Orthopedics of Shishi（Overseas Chinese） Hospital from June 2015 to July 2016, were selected and divided into the observation group（n=28） and the control group（n=29） according to the random number table method. The control group was treated with posterior pedicle screw fixation, and the observation group was treated with percutaneous pedicle screw change of fixation. The perioperative indicators of the two groups were compared, and the changes of vertebral imaging indexes were observed after one year of follow-up.Results The operation time, bleeding volume, postoperative ambulation time and hospitalization time in the observation group were（43.5±5.8） min,（80.6±25.4） m L,（7.5±2.4） d,（11.4±3.8） d, respectively, which were significantly less than（90.5±15.7） min,（230.7±55.9） m L,（13.4±4.3） d,（18.3±5.7） d in the control group（P0.05）. After one year of follow-up, the anterior vertebral height ratio and kyphosis Cobb angle were respectively（85.4±17.6）% and（9.9±2.8）° in the observation group versus（87.5±18.9）% and（9.1±3.2）° in the control group（P0.05）. Conclusion Percutaneous pedicle screw fixation is an effective method for the treatment of thoracolumbar fractures. It has advantages of shorter operation time, less blood loss and quick recovery.