经皮椎弓根螺钉与后路椎弓根螺钉内固定治疗胸腰椎骨折的疗效及预后比较

Comparison of the efficacy and prognosis of percutaneous pedicle screw fixation with posterior pedicle screw fixation for thoracolumbar fractures

目的探讨经皮椎弓根螺钉与后路椎弓根螺钉内固定治疗胸腰椎骨折的临床效果。方法将2017年6月—2019年1月本院收治的86例胸腰椎骨折患者,按手术入路不同分为两组,各43例。研究组行经皮椎弓根螺钉内固定术治疗,对照组行后路椎弓根螺钉内固定术治疗。观察两组围术期指标、影像学指标及并发症发生率。结果研究组手术时间、术中出血量、术后卧床时间、术后住院时间均少于对照组,差异有统计学意义(P<0.001);相较于术前,术后7d两组椎体前缘高度比值均增高、后凸Cobb角均减小,差异有统计学意义(P<0.001);术后7d两组椎体前缘高度比值、后凸Cobb角对比,差异无统计学意义(P>0.05);研究组并发症少于对照组,差异有统计学意义(P<0.05)。结论经皮椎弓根螺钉与后路椎弓根螺钉内固定均可有效减轻胸腰椎骨折症状,纠正胸腰椎畸形;但相较于后路椎弓根螺钉内固定,经皮椎弓根螺钉内固定具有手术时间短及术中出血量少、并发症少等相关微创优势,能缩短患者恢复时间,利于预后。

Objective To investigate the clinical efficacy of percutaneous pedicle screw fixation and posterior pedicle screw fixation for thoracolumbar fractures.Methods Eighty-six patients with thoracolumbar fractures admitted to our hospital from June 2017 to January 2019 were divided into two groups according to the surgical approach,43 cases in each group.The study group underwent percutaneous pedicle screw fixation and the control group underwent posterior pedicle screw fixation.The perioperative index,imaging index and complication rate of the two groups were observed.Results The operation time,intraoperative blood loss,postoperative bed rest time,postoperative duration of hospital stay were shorter and intraoperative blood loss was less in the study group than those in the control group,and the differences were statistically significant(P<0.001).In the two groups,postoperative(7 days)ratio of the height of the vertebral body leading edge increased and the Cobb angle of the kyphosis decreased by comparing with the preoperative ones,the differences were statistically significant(P<0.001).There was no significant difference by comparing the height of the vertebral body leading edge and the kyphosis Cobb angle at 7 days after operation between the two groups(P>0.05).The study group had fewer complications than the control group,and the difference was statistically significant(P<0.05).Conclusion Percutaneous pedicle screw fixation and posterior pedicle screw fixation can effectively alleviate the symptoms of thoracolumbar fracture and correct the thoracolumbar deformity.However,compared with posterior pedicle screw fixation,percutaneous pedicle screw fixation has the advantages of short operation time,less intraoperative blood loss,less complications,and other minimally invasive advantages,which can shorten the recovery time of patients and benefit prognosis.