后路经皮微创和椎旁肌入路椎弓根螺钉内固定术治疗胸腰椎体骨折疗效观察

CLINICAL OBSERVATION ON TREATMENT OF THORACOLUMBAR VERTEBRAL FRACTURES WITH POSTERIOR PERCUTANEOUS MINIMALLY INVASIVE AND PARAVERTEBRAL MUSCLE APPROACH PEDICLE SCREW FIXATION

目的观察后路经皮微创和椎旁肌入路椎弓根螺钉内固定术治疗胸腰椎体骨折的疗效。方法回顾性分析2016年12月—2018年12月之间在四川省南充市中心医院行手术治疗胸腰椎体骨折的90例病例资料,根据手术方式不同分为A组(48例)和B组(42例),A组利用后路经皮微创入路椎弓根螺钉内固定术治疗,B组选用椎旁肌入路椎弓根螺钉内固定术治疗,比较二组患者围手术期指标、手术前后影像学参数、腰痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)结果以及术后并发症情况。结果A组切口长度、术中出血量均低于B组,手术时间长于B组(P<0.05);二组术后5d、3个月、6个月的VSI指数、Cobb角比较,差异均无统计学意义(P>0.05)。二组术前、术后6个月VAS和ODI评分比较,差异无统计学意义(P>0.05)。二组术后并发症率比较差异无统计学意义(P>0.05)。结论后路经皮微创椎弓根螺钉内固定术治疗胸腰椎体骨折的疗效与旁肌入路椎弓根螺钉内固定术相似,但切口更小、术中出血更少,利于患者术后功能恢复。

Objective To observe curative effect of pedicle screw intemal fixation(PSIF)through percutaneous minimally invasive posterior approach and paraspinal muscle approach on thoracolumbar vertebral fractures(TVF).Methods A retrospective analysis was performed on data of ninety TVF patients who underwent surgery in the Central Hospital of Nanchon from December 2016 to December 2018.According to different surgical methods,they were divided into group A(48 cases)and group B(42 cases).Group A was treated with PSIF through percutaneous minimally invasive posterior approach,while group B was treated with PSIF through paraspinal muscle approach.Perioperative indexes,imaging parameters before and after surgery,score of visual analog scale(VAS),Oswestry dysfunction index(ODI)and postoperative complications were compared between the two groups.Results The incision length and intraoperative blood loss in group A were lower than those in group B,while operation time was longer than that in group B(P<0.05).At 5 d,3 months and 6 months after surgery,there was no significant difference in VSI index or Cobb angle between the two groups(P>0.05).Before surgery and at 6 months after surgery,there was no significant difference in VAS or ODI score between the two groups(P>0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusion The curative effect of both PSIF through percutaneous minimally invasive posterior approach and paraspinal muscle approach is similar on TVF.However,it is somewhat obvious in improving perioperative indexes.They can be chose according to actual situation of patients.