经皮椎弓根螺钉内固定治疗单节段无神经症状胸腰椎骨折临床效果观察

Analysis on the clinical effects of percutaneous pedicle screw fixation for single segment thoracolumbar fractures without neurological symptoms

目的:观察经皮椎弓根螺钉内固定治疗单节段无神经症状胸腰椎骨折临床疗效。方法:选取2015年9月-2016年10月我院收治的单节段无神经症状胸腰椎骨折患者75例为研究对象,随机分为开放手术行椎弓根螺钉内固定治疗组(对照组,37例)和经皮椎弓根螺钉内固定治疗组(观察组,38例),比较两组患者的手术切口长度、术中出血量、住院时间等手术指标,术后2 d、6个月、1年的视觉模拟评分(VAS评分),术后6个月、1年的Oswestry功能障碍指数评分(ODI评分)。结果:与对照组比较,观察组的切口长度更短、术中出血量更少,住院时间更短,差异均非常显著(P均<0.05)。观察组患者术后2 d的VAS评分明显低于对照组(P<0.05)。两组术后6个月、1年后的VAS评分及ODI评分没有明显差异(P>0.05)。观察组术后影像学参数中的伤椎Cobb角、椎体前缘高度比值、Worter指数等指标与对照组比较差异无显著性(P>0.05)。结论:经皮椎弓根螺钉内固定治疗单节段无神经症状胸腰椎骨折临床疗效显著,中远期疗效与开放性手术相似,但可减少术中出血,缩短手术时间,减轻手术创伤,缓解术后短期疼痛,效果显著。

Objective： To observe the clinical efficacy of percutaneous pedicle screw fixation in treatment of single segment thoracolumbar fractures without neurological symptoms. Methods： Seventy-five patients with single-segment no-sympathetic thoracolumbar fracture, admitted in the Third People＇s Hospital of Anyang from Sep. 2015 to Oct. 2016, were involved in present study, and randomly divided into control group（open surgery pedicle screw fixation, n=37） and observation group（percutaneous pedicle screw fixation, n=38）. The length of incision, intraoperative bleeding, hospitalization time, visual analog scale（VAS） scores on day-2, and 6 and 12 months after operation, as well as the Oswestry dysfunction index（ODI） scores 6 and 12 months after operation were compared between the two groups. Results： Compared with the control group, the shorter length of incision, less intraoperative bleeding and shorter hospitalization time were in the observation group with significant differences（P〈0.05）. The VAS score on day-2 after operation was significantly lower in observation group than in control group（P〈0.05）. No significant difference existed between the two groups in VAS and ODI scores 6 and 12 months after operation（P〉0.05）. Also no significant differences were found in the postoperative imaging parameters of Cobb angle, vertebral height ratio and Worter index between the two groups（P〉0.05）. Conclusions： Percutaneous pedicle screw fixation may achieve significant clinical efficacy in treatment of single segment thoracolumbar fractures without neurological symptoms, of which the medium-term and prospective efficacy is similar to that made by open surgery, but can reduce intraoperative bleeding, shorten the operation time, reduce surgical trauma and relieve short-term postoperative pain, and the effect is remarkable.