经皮微创脊柱内固定系统治疗创伤性胸腰段骨折的疗效及炎症应激反应观察

Clinical efficacy of minimally invasive percutaneous pedicle screw fixation for traumatic thoraco-lumbar fracture and its influence on inflammation stress response

目的探讨经皮微创脊柱内固定系统治疗创伤性胸腰段骨折的疗效及对炎症应激反应的影响。方法创伤性胸腰椎骨折病人68例,根据治疗方法分为两组。观察组疗34例,行经皮微创脊柱内固定系统治;对照组34例,行传统后路椎弓根内固定治疗。分析两组手术基本情况,手术前后测定外周血炎症应激反应指标[C-反应蛋白(CRP)、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-1β)、高迁移率族蛋白(HMGB)-1、单核细胞趋化蛋白(MCP)-、肌酸激酶(CK)、皮质醇(Cor)、前列腺素E_2(PGE_2)、去甲肾上腺素(NE)],评价疼痛视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI),测定脊柱复位效果。结果观察组和对照组手术切口、手术时间、术中出血量、术后住院时间、骨折愈合时间比较,差异有统计学意义(P<0.05);观察组术后1天、3天、7天血清CRP、TNF-α、IL-1β、HMGB-1、MCP-1、CK、Cor、PGE_2和NE水平均低于对照组(P<0.05);术后1周、3个月和末次随访,观察组的VAS评分和ODI评分均低于对照组,观察组的顽固性腰背痛发生率(2.94%)较对照组(14.71%)明显降低(P<0.05);两组术后伤椎前缘高度压缩比、Cobb角比较差异无统计学意义(P>0.05)。结论经皮微创脊柱内固定系统治疗创伤性胸腰段骨折疗效确切,创伤小且复位效果好,能够减少术后炎症应激反应,缩短术后康复时间。

Objective To investigate the curative effect of the minimally invasive percutaneous pedicle screw fixation for traumatic thoracolumbar fracture and its influence on inflammation stress re- sponse. Methods 68 patients with traumatic thoracolumbar fractures were divided into two groups ac- cording to the different surgical methods, 34 patients underwent minimally invasive percutaneous pedicle screw fixation（ observation group）and 34 patients underwent traditional posterior pedicle screw fixation （control group）. The basic surgical conditions of the two groups were analyzed, the inflammation stress re- sponse indexes [ C -reactive protein （ CRP ）, tumor necrosis factor-or （ TNF-α）, interleukin-1β （ IL- 1β ）, high mobility group box 1 （ HMGB-1 ）, monocyte chemoattractant protein-1 （ MCP-1 ）, creatine kinase （ CK）, cor- tisol（ Cor）, prostaglandin E2 （ PGE2 ）, norepinephrine （ NE ） ] were detected, the spinal reduction effect was measured. Results The operative incision, operation time,intraoperative bleeding, hospital stay, frac- ture healing time weeks between the observation group and control group were significant（ P 〈 0.05 ）. On the 1 st,3rd and 7th day after operation, the serum levels of CRP, TNF-α, IL-1β, HMGB-1, MCP-1, CK, Cor,PGE2 and NE in the observation group were significantly lower than those in the control group（ P 〈 0.05 ）. On the 1st week,3rd months and last follow-up after operation ,the scores of VAS and ODI in the observation group were significantly lower than those in the control group （ P 〈 0.05 ）, and the incidence of intractable low back plain in the observation group was significantly lower than that in the control group （2.94 % vs 14.71%, P 〈 0.05） ;There were no significant difference of compression ratio of leading edge of vertebral body height, Cobb anglebe tween the two groups （ P 〉 0.05 ）. Conclusion Minimally invasive percutaneous pedicle screw fixation is effective for traumatic thoracolumbar fracture, which has less trau- ma and good reset effect, can reduce postoperative inflammatory stress response and shorten postoperative recoverv time.