经皮椎弓根螺钉与传统开放式手术治疗A3型胸腰椎骨折临床疗效比较

Comparison of the Effects of Minimally Invasive Percutaneous Pedicle Screw Fixation and Conventional Open Spinal Internal Fixation on Type A3 Thoracolumbar Vertebra Fracture

目的对比经皮椎弓根螺钉与传统开放脊柱内固定手术治疗胸腰椎骨折的临床疗效。方法回顾性研究纳入2010年12月20日至2015年1月31日入住骨科86名胸腰椎骨折患者,患者年龄15～56岁之间, AO分类A3型胸腰椎骨折不伴有神经症状,接受经皮椎弓根螺钉的微创手术治疗或传统开放手术治疗。比较2组围手术期相关指标及伤椎Cobb角和椎体前缘高度丢失情况。结果微创组患者术中出血量,住院时间均优于开放组;术后2组间VAS评分及ODI值有统计学意义(P<0.05),远期随访2组间无统计学意义(P>0.05)。2组间伤椎局部Cobb角无统计学意义;椎体前缘高度复位丢失有统计学意义,微创组显著大于开放组(P<0.05)。结论经皮椎弓根钉能有效地治疗A3型胸腰椎骨折,出血少,创伤小,恢复快,远期临床疗效满意,尤其适合年轻患者。

Objective To compare the clinical efficacy of percutaneous pedicle screw fixation with conventional open spinal internal fixation for type A3 thoracolumbar fractures. Methods The retrospective study consisted of 86 patients who received minimally invasive fixation or open fixation. Patients were between 15 and 56 years of age, had a thoracolumbar fracture and no neurological deficits. Kyphotic angle(Cobb angle) and loss of reduction was compared after minimal invasive and open fixation. The Cobb angle was evaluated directly postoperatively, at 1 week, 6 months and 12 months after surgery. Results Patients who received the minimally invasive fixation had a shorter surgical intervention time and a shorter hospital stay compared to patients who received the open fixation. There was no significant difference in the local Cobb angle between the two groups;the minimally invasive group was significantly different than the open group in the loss of the anterior border of the vertebral body.Conclusions In this study we provide evidence that percutaneous pedicle screw can effectively treat type A3 thoracolumbar fractures with less bleeding, less trauma and quick recovery. This method acquires satisfactory clinical results in long-term follow-up, especially for young patients.