经皮微创椎弓根钉技术治疗胸腰椎骨折168例疗效及安全性评价

Evaluation on the efficacy and safety of percutaneous minimally invasive pedicle screw technique in the treatment of 168 cases of thoracolumbar fractures

目的探究经皮微创椎弓根钉技术治疗胸腰椎骨折的疗效及安全性。方法选取我院2014年1月~2017年1月期间收治的确诊为胸腰椎骨折的336例患者为研究对象,采用随机数表法分组,对照组(n=168)采用切开复位内固定术,观察组(n=168)采用经皮微创椎弓根钉技术。比较两组的围手术期相关指标、矫形效果、疼痛情况的差异,评估两组疗效,观察并发症。结果两组的手术时间无明显差异(P>0.05);与对照组比,观察组的术中出血量少、住院时间短、手术切口小,差异均有统计学意义(P<0.05);与术前比,在术后的1、6、12个月两组的椎体前缘高度比、Cobb角均有明显改善(P<0.05),观察组术后1个月的椎体前缘高度比小于对照组(P<0.05);观察组在术后第1个月的VAS疼痛评分低于对照组(P<0.05);观察组治疗总效率明显高于对照组(P<0.05);观察组和对照组分别出现8例(4.76%)、11例(6.55%)切口愈合不良的病例,两组均未出现严重并发症,差异无统计学意义(P>0.05)。结论经皮微创椎弓根钉技术治疗胸腰椎骨折的效果与传统切开复位术相当,且其具有创伤小、减少出血量、减轻术后疼痛的优势,促进患者术后康复。

Objective To investigate the efficacy and safety of percutaneous minimally invasive pedicle screw technique in the treatment of thoracolumbar fractures. Methods A total of 336 patients with confirmed thoracolumbar fractures who were admitted to our hospital from January 2014 to January 2017 were selected as study subjects. The random number table method was applied. The control group （n=168） was given open reduction and internal fixation. The observation group （n=168） was given percutaneous minimally invasive pedicle screw technique. The perioperative related indicators, orthopedic effects, and pain conditions were compared between the two groups. The efficacy of the two groups was evaluated and complications were observed. Results There was no significant difference in the operation time between the two groups（P〉0.05）; compared with the control group, there were less intraoperative blood loss, shorter hospital stay, and smaller surgical incision in the observation group, and the differences were statistically significant（P〈 0.05）; compared with those before surgery, the anterior height ratio of the vertebral body and the Cobb angle at the 1st, 6th, and 12th months after operation were significantly improved（P〈0.05）. The anterior height ratio of the vertebral body in the observation group 1 month after surgery was smaller than that in the control group （P〈0.05）; the VAS pain score in the observation group at the first postoperative month was lower than that in the control group（P〈O.05）. The total treatment efficiency in the observation group was significantly higher than that in the control group （P〈O.05）; there were 8 patients（4.76%） and 11 patients （6.55%） who had poor incision healing in the observation group and the control group respectively. No serious complications were found in either group, and the difference was not statistically significant（P〉 0.05）. Conclusion The effect of percutaneous minimally invasive pedicle screw technique in the treatment of thoracolumbar fractures is similar to that of traditional open reduction surgery. It has the advantages of less trauma, less bleeding and less postoperative pain, which can promote patients＂ postoperative recovery.