经皮椎弓根螺钉固定治疗无神经损伤单节段胸腰椎骨折的临床效果

Clinical Effect of Percutaneous Pedicle Screw Fixation in the Treatment of Single Segment Thoracolumbar Fractures without Nerve Injury

目的比较经皮或开放性椎弓根螺钉固定(PPSF或OPSF)治疗无神经损伤单节段胸腰椎骨折的临床效果。方法纳入因无神经损伤单节段胸腰椎骨折行PPSF或OPSF的患者各34例分别作为病例组和对照组,术后随访1年,比较两组围术期参数、临床效果及并发症发生率等资料。结果病例组切口长度、手术时间、术中出血量及住院时长显著低于对照组,差异有统计学意义(P<0. 05);病例组术后3d和2周时NRS疼痛评分、术后2周和3月时Oswestry功能障碍指数(ODI)均显著低于对照组,差异有统计学意义(P<0. 05);两组患者术前及术后各时间点伤椎椎体前缘高度、Cobb角及椎体指数比较差异无统计学意义(P>0. 05);两组患者术后切口发红、切口延长渗液及背部僵硬感发生率差异无统计学意义(P>0. 05),均未出现感染及内固定失效。结论 PPSF在治疗无神经损伤单节段胸腰椎骨折中不仅可获得与OPSF相似的术后影像学结果,还具有创伤小、出血少、手术及住院时间短、术后疼痛缓解及功能康复快等优点,值得临床应用及推广。

Objective To compare the clinical effect of percutaneous or open pedicle screw fixation（ PPSF or OPSF） in the treatment of single segment thoracolumbar fractures without nerve injury. Methods patients with single thoracolumbar vertebrae fracture without nerve injury which were treated with PPSF or OPSF were respectively included in case group and control group,34 cases in each group.After 1 year follow-up,The data of perioperative parameters,clinical effects and complications were compared between the two groups.Results The length of incision,the time of operation,the amount of intraoperative bleeding and the length of hospitalization in the case group were significantly lower than those in the control group（ P〈0.05）; In the case group,the scores of NRS pain on the 3rd day and 2nd week after operation and the Oswestry dysfunction index（ ODI） on the 2nd week and 3rd month after operation were all significantly lower than those in the control group（ P〈0.05）; There was no significant difference in anterior height,Cobb angle and vertebral body index of the injured vertebral body between the two groups before and after operation at different time points（ P〉0.05）; There was no significant difference in the incidence of incision redness,incision prolonged exudation and back stiffness between the two groups（ P〉0.05）,no infection or failure of internal fixation in the two groups.Conclusion In the treatment of single segment thoracolumbar fracture without nerve injury,PPSF can not only obtain similar postoperative imaging results as OPSF,but also have the advantages of less trauma,less bleeding,shorter operation and hospital stay,better postoperative pain relief and faster functional rehabilitation,which is worthy of clinical application and promotion.