微创经皮定向椎弓根螺钉内固定技术治疗单纯性胸腰椎骨折的应用价值

Application value of minimally invasive percutaneous pedicle screw fixation in the treatment of simple thoracolumbar fractures

目的探讨微创经皮定向椎弓根螺钉内固定技术治疗单纯性胸腰椎骨折的效果。方法选取2016年1月—2017年12月本院收治的单纯性胸腰椎骨折患者60例作为研究对象,随机数表法分为开放组和微创组两组,每组各30例,分别通过传统开放疗法及微创疗法行椎弓根螺钉内固定治疗。比较两组患者术中出血量、切口长度、手术时间、术后住院时间、骨折愈合时间、治疗前后视觉模拟评分法(Visual Analogue Scale/Score,VAS)、腰椎功能障碍指数(Oswestry Dability Index,ODI)、矢状面Cobb's角和病椎椎体前缘高度及椎间隙高度间的差异。结果微创组相比于开放组术中出血量少,手术切口较小,手术时间及住院时间短,骨折愈合时间短,上述差异均有统计学意义(P<0.05);两组患者术后7天腰部疼痛的VAS及ODI评分均低于术前,相比于开放组,微创组VAS及ODI评分更低(P<0.05);患者术后一年矢状面Cobb's角、病椎椎体前缘高度和椎间隙高度均有明显改善(P<0.05),均有效纠正了后凸畸形,但两组间手术前后矢状面Cobb's角、病椎椎体前缘高度和椎间隙高度差异无统计学意义(P>0.05)。结论微创经皮定向椎弓根螺钉内固定技术治疗单纯性胸腰椎骨折在有效治疗疾病的同时可明显减小对组织的创伤,降低出血量,缩短手术时间,并能有效缩短患者的恢复时间,经皮微创的方法在治疗单纯性胸腰椎骨折方面有极大的临床应用价值。

Objective To investigate the effect of minimally invasive percutaneous pedicle screw fixation in the treatment of simple thoracolumbar fracture.Methods Sixty patients with simple thoracolumbar fractures those who received treatment in our hospital from January 2016 to December 2017 were selected as study subjects and randomly divided into open group and minimally invasive group,30 cases in each group.Patients were treated by traditional open method and minimally invasive root screw internal fixation treatment method,respectively.The intraoperative blood loss,incision length,operation time,postoperative hospital stay,fracture healing time,scores of visual analog scale(SAS),and lumbar dysfunction index(Oswestry Dability Index,ODI),the sagittal Cobb's angle and the height of the vertebral body leading edge and the height of the intervertebral space were compared between the two groups.Results Compared with the open group,the minimally invasive group had less bleeding,less incision,shorter operation time and hospital stay,and shorter fracture healing time.The above differences were statistically significant(P<0.05).The VAS and ODI scores of lumbar pain were lower than those before surgery.Compared with the open group,the VAS and ODI scores in the minimally invasive group were lower(P<0.05).One year after operation,the sagittal Cobb's angle and the vertebral vertebrae the height of the anterior border and the height of the intervertebral space were significantly improved(P<0.05),and all of them were effective in correcting the kyphosis.However,the differences between the two groups were not statistically significant(P>0.05).Conclusions Minimally invasive percutaneous pedicle screw fixation for the treatment of simple thoracolumbar fractures could significantly reduce the trauma to the tissue,reduce the amount of bleeding,shorten the operation time,and effectively shorten the recovery time of patients.The minimally invasive method has great clinical value in the treatment of simple thoracolumbar fractures.