微创经皮椎弓根螺钉内固定术治疗单纯性下胸椎及腰椎骨折的疗效分析

Clinical effect of minimally-invasive percutaneous pedicle screw fixation for the treatment of simple lower thoracic and lumbar fractures

目的探讨微创经皮椎弓根螺钉内固定术对单纯性下胸椎及腰椎骨折的治疗效果及安全性。方法回顾性分析2015年9月—2017年4月太和医院武当山分院骨科接受治疗的无神经损伤下胸椎及腰椎骨折患者98例,其中50例患者接受微创经皮椎弓根螺钉内固定术(微创组),48例患者接受开放后路跨伤椎椎弓根螺钉内固定术(开放组)。观察对比两组患者的临床疗效、围手术期指标(切口长度、术中失血量、手术时间、引流量、住院时间)、影像学指标(术椎椎体前缘、后缘高度比、Cobb氏角、伤椎worter指数)、炎症状态(血清肌酸激酶水平、MRI扫描炎性水肿区域体积)、术后并发症发生率。结果微创组患者术中出血量、切口长度、术后引流量以及住院时间明显短于开放组患者(P>0.05)。术后1周和术后6个月随访时,两组患者Cobb角、伤椎前缘高度比值、伤椎后缘高度比值、Worter指数都较术前有明显改善,但是两组差异无统计学意义(P>0.05)。术后1周,微创组患者VAS评分和ODI评分明显优于开放组(P<0.05)。而术后6个月后,两组患者VAS评分和ODI评分基本一致(P>0.05)。术后1d、3d、1周后,微创组患者肌酸激酶水平以及MRI扫描炎性水肿区域体积低于开放组(P<0.05)。另外,开放组有4例患者出现术后并发症。结论微创内固定术和传统开放手术均可改善单纯性下胸椎及腰椎骨折患者的临床症状,但是微创经皮椎弓根螺钉内固定术可加速患者术后恢复,改善炎症状态,降低并发症发生风险,值得临床推广。

Objective To discuss the effect of minimally invasive percutaneous pedicle screw fixation for the patients with simple lower thoracic and lumbar fracture. Methods Totally 98 patients with simple lower thoracic vertebra and lumbar vertebra fracture without neural symptom in our hospital from Sep. 2015 to Apr. 2017 were collected in this study,including 50 patients in the minimally invasive group with minimally invasive percutaneous pedicle screw fixation and 48 patients in the open group with open pedicle screw fixation. The clinical efficacy,incision length,bleeding volume,operation time,post-operative drainage volume,hospital stay,ratio of leading edge height of vertebral body,Cobb angle,Worter index,incidence of complications,the serum values of creatine kinase（ CK） and the volume of inflammatory edema area were compared between the minimally invasive group and open group. Results The incision length,bleeding volume,post-operative drainage volume,hospital stay of patients in minimally invasive group were less than those of the open group（ P 0. 05）. At 1 week and 6 months after surgery,the ratio of leading edge height of vertebral body,Cobb angle,Worter index of patients in both groups were improved than before surgery（ P 0. 05）,while there was no difference in these indexes between the two groups（ P 0. 05）.At 1 week after surgery,the VAS score and ODI score of patients in minimally invasive group were superior to patients in the open group（ P 0. 05）. But there was no difference of VAS score and ODI score between the two groups of 6 months after surgery（ P 0. 05）. At 1 day,3 days and 1 week after surgery,the serum CK values and volume of inflammatory edema area of patients in minimally invasive group were less than those of the open group（ P 0. 05）. Besides,there were 4 patients with complications in the open group. Conclusion It is suggested that minimally invasive internal fixation and traditional open surgery can improve the clinical symptoms of simple lower thoracic vertebra and lumbar vertebra fractures,but minimally invasive percutaneous pedicle screw fixation can accelerate the recovery of the patients,improve the state of inflammation and reduce the risk of complications. It is worthy of clinical promotion.