经皮与开放椎弓根螺钉内固定治疗脊柱骨折疗效对比

Therapeutic Effect Comparison of Minimally Invasive Percutaneous Pedicle Screws Osteosynthesis and Open Pedicle Screws Osteosynthesis in the Treatment of Spinal Fracture

目的对比分析经皮与开放椎弓根螺钉内固定治疗脊柱骨折的临床疗效。方法选取2016年3月至2018年3月贵州水矿控股集团有限责任公司总医院骨科收治的90例脊柱骨折患者作为研究对象,采用随机数表法将其随机分为观察组(45例)和对照组(45例),其中观察组患者行经皮椎弓根螺钉内固定术治疗,对照组患者行开放椎弓根螺钉内固定术治疗,对比观察两组患者术中出血量、手术时间、下地时间、住院时间、VAS量表评分、NRS量表评分以及C 反应蛋白(CRP)、白介素 6(IL 6)、肿瘤坏死因子 α(TNF α)水平变化情况与切口感染、创伤性截瘫、运动障碍等并发症发生情况。结果观察组患者术中出血量明显少于对照组,手术时间、下地时间及住院时间均明显短于对照组,两组患者术中出血量、手术时间、下地时间及住院时间对比,P均<0.05,差异具有统计学意义;术后14 d时,观察组患者VAS评分与NRS评分以及CRP、IL 6及TNF α水平均明显低于对照组,两组患者VAS评分与NRS评分以及CRP、IL 6及TNF α水平组间对比,P均<0.05,差异具有统计学意义;术后14 d内,观察组患者并发症发生率为6.67%,与对照组患者的并发症发生率24.44%对比,P>0.05,差异无统计学意义。结论相对于开放椎弓根螺钉内固定术而言,经皮椎弓根螺钉内固定术治疗脊柱骨折手术时间更短,术中出血量更少,患者恢复更快,且术后疼痛程度较低,值得临床推广应用。

Objective To compare the therapeutic effects of minimally invasive percutaneous pedicle screws osteosynthesis(MIPPSO)and open pedicle screws osteosynthesis(OPSO)in the treatment of spinal fracture.Methods Ninety patients with spinal fracture admitted into the Orthopedics Department of the General Hospital of Guizhou Shuicheng Coal Mining(Group)Co.,Ltd.between March 2016 and March 2018 were selected as subjects to be divided into an observation group(45 patients)and a control group(45 patients)according to the random number table.In the observation group the patients were treated with MIPPSO while the patients in the control group were treated with OPSO.The following items were observed and compared between the two groups including the bleeding volume during the operation,operation time,ambulation time,length of hospital stay,VAS score,NRS score,expression levels of C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor-a(TNF-α),as well as the occurrence of complications such as incision infection,traumatic paraplegia,movement disorders and etc.Results Compared with the control group,the bleeding volume during the operation in the observation group was obviously less,and the operation time,ambulation time and the length of hospital stay were all markedly shorter,and the differences were all statistically significant(P<0.05).On day 14 postoperation,the VAS score,NRS score,and the expression levels of CRP,IL-6 and TNF-α in the observation group were all obviously lower than that in the control group,and the differences were statistically significant,all P<0.05.During the 14 days postoperation,the incidence of complications in the observation group was 6.67%,which showed a statistically significant difference as compared with the higher 24.44% in the control group(P<0.05).Conclusion Compared with the OPSO,the MIPPSO presented a shorter operation time,less bleeding volume during the operation,faster patients’ recovery,less postoperative pain and lower occurrence of complications,deserving to be promoted in clinical practice.