经皮经单侧伤椎椎弓根螺钉内固定术治疗胸腰椎骨折的效果

Percutaneous transpedicular screw internal fixation in the treatment of thoracolumbar fracture

目的观察采用经皮经单侧伤椎椎弓根螺钉内固定术治疗胸腰椎骨折的方法及效果。方法选取2014年5月至2016年8月治疗的36例胸腰椎骨折患者作为研究对象,按不同施术方式分为对照组16例(使用传统开放术治疗)和观察组20例(经皮经单侧伤椎椎弓根螺钉内固定术治疗)。观察比较两组患者的手术时间、住院时间、手术出血情况,术前术后椎体前缘高度比、疼痛评分(VAS评分)和伤椎Cobb角变化。术后随访1年,按Macnab标准评估患者恢复情况并记录两组并发症发生情况。结果观察组术中出血量[(69.65±8.32)ml vs(218.26±12.39)ml]和住院时间[(9.14±2.37)d vs(15.06±3.61)d]低于对照组,差异有统计学意义(P均<0.01);治疗后两组Cobb角小于术前(P均<0.01),但两组Cobb角比较差异无统计学意义(P>0.05);治疗后两组椎体前缘高度比和VAS评分显著优于治疗前,且观察组优于对照组,差异均有统计学意义(P<0.05,P<0.01);随访1年后,观察组优良率为95.00%,稍高于对照组的68.75%,但差异无统计学意义(P>0.05)。结论经皮经单侧伤椎椎弓根螺钉内固定术能够显著提高患者术后恢复速度及治疗效果,减轻患者疼痛,但本研究样本量少,仍需大样本实验研究证实。

Objective To observe the clinical effect of percutaneous unilateral vertebral pedicle screw fixation in the treatment of thoracolumbar fractures. Methods Thirty-six patients with thoracic fractures treated from May 2014 to August2016 were selected and randomly divided into traditional open surgery group（ control group,n = 16） and percutaneous unilateral vertebral pedicle screw fixation group（ research group,n = 20）. The operative time,hospital stay,intraoperative bleeding,preoperative and postoperative ratio of vertebral anterior height,visual analogue scale（ VAS） and changes of Cobb＇s angle at the injured vertebra were observed and compared between two groups. During 1-year follow-up,the recovery of patients was evaluated according to the Macnab standard,and the incidence of complications was recorded in two groups. Results The intraoperative blood loss [（ 69. 65 ± 8. 32） ml vs（ 218. 26 ± 12. 39） ml] and hospital stay [（ 9. 14± 2. 37） d vs（ 15. 06 ± 3. 61） d] in experimental group were lower than those in control group（ all P〈0. 01）. The postoperative change in Cobb angle was significantly greater than that before operation in both two groups（ all P〈0. 01）,however,there was no significant difference in it between two groups（ P〈0. 05）. After treatment,the ratio of vertebral body height and VAS score were significantly better than those before treatment in two group（ P〈0. 05） and were significantly better in experimental group than those in control group（ P〈0. 05,P〈0. 01）. After 1-year follow-up,the excellent rate of postoperative recovery in experimental group（ 90. 00%） was slightly higher than that in control group（ 75. 00%）,but there was no statistical difference（ P〉0. 05）. Conclusions Percutaneous screw pedicle screw fixation can obviously improve the recovery rate and curative effect of the patients and reduce the incidence of pain and complication after surgery. However,large-sample experimental research is needed for further confirmation.