经皮椎弓根钉和经椎旁肌间隙入路椎弓根钉系统治疗单节段胸腰椎骨折的临床疗效比较

Comparison of clinical outcomes between percutaneous pedicle screw and pedicle screw system through paraspinal muscle approach for single thoracolumbar fracture

背景:经皮椎弓根钉和经椎旁肌间隙入路椎弓根钉系统均已广泛应用于胸腰椎骨折的治疗,且都符合微创手术的理念,但两种手术方式的优劣还不明确。目的:探讨采用经皮椎弓根钉和经椎旁肌间隙入路椎弓根钉系统治疗单节段胸腰椎骨折的临床疗效。方法:选取2014年5月至2017年12月收治的72例单节段胸腰椎骨折患者为研究对象,采用经椎旁肌间隙入路椎弓根螺钉系统41例(椎旁肌组),经皮椎弓根螺钉31例(经皮组)。比较2组患者的切口长度、手术时间、术中及术后出血量、术中透视次数、住院天数,测量后凸Cobb角矫正率、伤椎椎体前缘高度百分比、椎体复位后再丢失高度值,评估术后1周及6个月腰背痛疼痛视觉模拟评分法(visual analogue scale, VAS)评分及术后6个月Oswestry功能障碍指数评分,观察临床疗效。结果:所有患者均顺利完成手术并获得随访。随访时间6～12个月。椎旁肌组手术时间、术中透视次数、椎体复位后再丢失高度值显著低于经皮组(P<0.05),而经皮组术中及术后出血量、住院天数、后凸Cobb角矫正率、术后伤椎椎体前缘高度百分比、术后1周VAS评分显著低于椎旁肌组(P<0.05)。两组患者的切口长度、术后6个月VAS评分、Oswestry功能障碍指数评分比较,均无显著统计学差异(P>0.05)。结论:经皮椎弓根钉和经椎旁肌间隙入路椎弓根螺钉系统治疗单节段胸腰椎骨折,均可获得较好的临床疗效。经皮椎弓根螺钉手术创伤更小、恢复更快,但相对于经椎旁肌间隙入路椎弓根螺钉系统需要更长的手术时间和更多的X线辐射,椎体复位效果和椎体高度维持也稍逊,同时手术操作要求相对更高。

Background： Both percutaneous pedicle screw and pedicle screw system through paraspinal muscle approach are widely applied in the treatment of thoracolumbar fractures. Both are in accord with ideas of minimally invasive surgery. But the advantages and disadvantages of the two methods are not clear. Objective： To compare clinical outcomes between percutaneous pedicle screw and pedicle screw system through paraspinal muscle approach in the treatment of thoracolumbar fractures.Methods： A total of 72 patients with single thoracolumbar fracture treated from May 2014 to December 2017 were as the research object. Of them, 41 cases used pedicle screw system through paraspinal muscle approach（paraspinal group）, and 31 cases used percutaneous pedicle screw（percutaneous group）. The operative incision length, operative time, intraoperative and postoperative bleeding volume, intraoperative fluoroscopy times, hospitalization days, kyphosis Cobb angle correction rate, percentage of anterior margin of vertebral body of injured vertebra and height of reposition of vertebral body after reduction were compared between the two groups. The waist backache visual analogue scale（VAS） score at 1 week and 6 months postoperatively, and Oswestry disability index（ODI） at 6 months postoperative were assessed, and the clinical efficacy was observed. Results： All the patients successfully completed the operation and postoperative follow-up. The follow-up ranged from 6 to 12 months. Paraspinal muscle group had shorter operation time, less intraoperative fluoroscopy times and less height of reposition of vertebral body after reduction（P〈0.05）, while percutaneous group had less bleeding volume, postoperative drainage, hospitalization days, kyphosis Cobb angle correction rate, percentage of vertebral anterior margin of vertebral body after operation,and VAS scores at 1 week postoperatively（P〈0.05）. There were no significant differences between the two groups in the operative incision length, VAS scores at 6 months postoperatively and ODI（P〈0.05）. Conclusions： Both percutaneous pedicle screw and pedicle screw system through paraspinal muscle approach can acquire satisfactory clinical curative effect in patients with thoracolumbar fractures. Percutaneous pedicle screw can achieve smaller surgical trauma and faster recovery. But compared with pedicle screw system through paraspinal muscle approach, it requires longer operative time and more X-ray radiation,and it has slightly inferior vertebral reduction and vertebral height preservation and higher requirement of operative procedure.