开放式手术与微创手术治疗胸腰椎骨折的临床效果比较

Comparison of clinical effects of open surgery and minimally invasive surgery in treatment of thoracolumbar fractures

目的:比较开放式手术和微创手术治疗胸腰椎骨折的效果。方法:选取90例胸腰椎骨折患者作为研究对象,依据随机数字表法将其分为对照组和观察组各45例。对照组采用传统开放式手术治疗,观察组采用经皮微创椎弓根钉内固定术治疗,比较手术前后两组影像学指标(椎体前缘高度、椎间隙高度和后凸Cobb角度)变化情况及手术指标(切口长度、手术时间、术中出血量、住院时间和卧床时间)的异同。结果:手术前后两组椎体前缘高度、椎间隙高度和后凸Cobb角度比较,差异均无统计学意义(P>0.05),同组治疗前后影像学指标相比,差异有统计学意义(P<0.05);观察组切口长度、手术时间及术中出血量均明显优于对照组,差异有统计学意义(P<0.05);两组间卧床时间和住院时间比较,差异有统计学意义(P<0.05);观察组的并发症发生率为6.7%,低于对照组的22.2%,差异有统计学意义(P<0.05)。结论:两种手术方式治疗胸腰椎骨折均可取得较好的效果,但与开放式手术相比,微创手术具有创伤小、术中出血少等优点,临床应用需要根据患者的具体病情选择合适的手术方式,以改善患者生命质量。

Objective: To compare effects of open surgery and minimally invasive surgery in treatment of thoracolumbar fractures. Methods: 90 patients with thoracolumbar fractures were selected as the research subjects, and they were divided into control group(n=45) and observation group(n=45) according to random number table method. The control group was treated with traditional open surgery, while the observation group was treated with percutaneous minimally invasive pedicle screw fi xation. The changes of imaging parameters(anterior vertebral height, intervertebral space height and kyphosis Cobb angle) before and after the operation were compared. Further the similarities and differences of surgical indicators(incision length, operation time, intraoperative blood loss, hospital stay and bed time) were also compared. Results: There were no signifi cant differences in the anterior vertebral height, intervertebral space height and kyphosis Cobb angle between the control group and the observation group before the surgery(P>0.05). In the same group, there were signifi cant differences in the imaging indexes before and after the treatment(P<0.05). The incision length, operation time and intraoperative blood loss were signifi cantly better in the observation group than in the control group, and the differences were statistically signifi cant(P<0.05). There were signifi cant differences between the two groups in the bed time and hospital stay(P<0.05). The complication rate of the observation group was 6.7%, which was lower than that of the control group(22.2%), and the difference was statistically signifi cant(P<0.05). Conclusions: Both surgical methods can achieve better results in the treatment of thoracolumbar fractures. However, compared with open surgery, the minimally invasive surgery has the advantages of less trauma and less intraoperative bleeding. In the clinic, it should choose the appropriate surgery according to the specifi c conditions of the patient in order to improve the quality of life.