折弯连接棒联合伤椎置钉杠杆复位经皮椎弓根钉内固定治疗胸腰椎骨折的疗效观察

Clinical outcomes of percutaneous pedicle screw fixation in injury vertebrae combined with curving rob lever reduction and internal fixation for thoracolumbar fractures

目的比较折弯连接棒联合伤椎置钉杠杆复位经皮内固定和传统椎弓根钉撑开复位内固定治疗胸腰椎骨折的临床疗效。方法回顾性分析自2014-08—2018-06诊治的60例单节段胸腰椎骨折,30例采用折弯连接棒联合伤椎置钉杠杆复位经皮内固定治疗(经皮组),30例采用传统开放椎弓根钉撑开复位内固定治疗(开放组)。比较2组手术时间、术中出血量、伤椎前缘高度比值、矢状面Cobb角、疼痛VAS评分及末次随访时ODI指数。结果经皮组随访时间平均11.6(6~24)个月,开放组随访时间平均12.3(6~23)个月。经皮组与开放组术后3 d伤椎前缘高度比值、矢状面Cobb角差异无统计学意义(P>0.05);但末次随访时经皮组伤椎前缘高度比值较开放组高,矢状面Cobb角较开放组低,差异有统计学意义(P <0.05)。经皮组术后3 d、末次随访时疼痛VAS评分及末次随访时ODI指数较开放组低,差异有统计学意义(P<0.05)。经皮组末次随访时伤椎前缘高度比值、矢状面Cobb角与术后3 d比较差异无统计学意义(P>0.05)。开放组末次随访时伤椎前缘高度比值、矢状面Cobb角存在丢失,差异有统计学意义(P <0.05)。结论折弯连接棒联合伤椎置钉杠杆复位经皮椎弓根钉内固定治疗胸腰椎骨折创伤小,具有术后恢复快、能有效恢复并维持伤椎高度、矫正脊柱后凸畸形及矫正丢失少的优点。

Objective To compare the clinical outcomes of percutaneous pedicle screw fixation in injury vertebrae combined with curving rob lever reduction and internal fixation and traditional pedicle screw distraction reduction and internal fixation for thoracolumbar fractures.Methods From August 2014 to June 2018,60 cases of single-level thoracolumbar fractures were retrospectively analyzed.Of them,30 cases received percutaneous pedicle screw fixation in injury vertebrate combined with curving rob lever reduction and fixation group(percutaneous group),while 30 cases underwent traditional open distraction reduction and internal fixation(open group).The operative time,intraoperative blood loss volume,the ratio of vertebral anterior margin height,the sagittal kyphosis Cobb angle and pain VAS and ODI index at last follow-up were compared between two groups.Results Sixty cases were followed up.The average follow-up time in the percutaneous group was 11.6(6-24)months,and 12.3(6-23)months in the open group.The ratio of vertebral anterior margin height and the sagittal kyphosis Cobb angle showed no statistically significant difference between two groups at postoperative 3 d(P>0.05).At last follow up,the ratio of vertebral anterior margin height in the percutaneous group was higher than that in the open group,and the sagittal kyphosis Cobb angle in the percutaneous was lower than that in the open group,there was statistically significant difference between two groups(P<0.05).Pain VAS in the percutaneous group was significantly better than that in the open group at postoperative 3 d and the last follow-up(P<0.05).In the percutaneous group,there was no significant difference in the ratio of vertebral anterior margin height,the sagittal kyphosis Cobb angle after operation 3 d and at last follow up(P>0.05),but in the open group,there were significant differences(P<0.05).Conclusion Percutaneous pedicle screw fixation in injury vertebrate combined with curving rob lever reduction and fixation can effectively restore and maintain the vertebral height,correct the kyphotic deformity and reduce the postoperative correction loss.It may be a minimally invasive,safe and effective surgical procedur for thoracolumbar fractures,which has the advantages of smaller surgical trauma,less blood loss and earlier recovery.