经皮与经多裂肌间隙入路椎弓根内固定术治疗单节段胸腰椎骨折的效果比较

Comparison of percutaneous versus multifidus approach pedicle screw fixation on single level thoracolumbar fractures

目的:比较经皮与经多裂肌间隙入路椎弓根内固定术治疗单节段胸腰椎骨折的临床效果。方法:抽取2016年8月至2019年8月郑州人民医院收治的单节段胸腰椎骨折患者62例,其中采用经皮椎弓根内固定术治疗26例(经皮组),经多裂肌间隙入路椎弓根内固定术36例(多裂肌组),记录两组患者切口长度、手术时间、出血量、术后引流量、住院天数,以及手术前后视觉模拟评分法(VAS)评分、Oswestry功能障碍指数(ODI)、手术前后伤椎前缘高度百分比、矢状面后凸Cobb角。结果:经皮组切口长度,出血量,术后引流量,住院天数,术后1 d、1周VAS评分低于多裂肌组(P<0.05),两组术后3、6个月VAS评分、ODI比较差异未见统计学意义(P>0.05),两组术后1周、6个月伤椎前缘高度百分比、后凸Cobb角比较差异未见统计学意义(P>0.05)。结论:经皮和经多裂肌间隙入路椎弓根内固定术治疗单节段胸腰椎骨折临床疗效均良好,但经皮椎弓根内固定术术中创伤更小,患者术后恢复更快。

Objective To compare the clinical efficacy of percutaneous and multifidus approach pedicle screw fixation in the treatment of single level thoracolumbar fractures.Methods Sixty-two patients with single level thoracolumbar fractures in Zhengzhou People’s Hospital from August 2016 to August 2019 were selected,among them,26 cases were treated by percutaneous pedicle screw fixation(percutaneous group),36 cases were treated by multifidus approach pedicle screw fixation(multifidus muscle group).The length of incision,operation time,intraoperative blood loss,postoperative drainage,hospitalization days,preoperative and postoperative visual analogue scale(VAS)score and Oswestry dysfunction index(ODI),percentage of anterior height of injured vertebra and Cobb angle before and after operation were recorded and compared between the two groups.Results The length of incision,intraoperative blood loss,postoperative drainage,hospitalization days,VAS score of 1 day and 1 week after operation in percutaneous group were lower than those in multifidus muscle group(P<0.05).There was no significant difference between the two groups in the VAS scores and ODI at 3 months and 6 months postoperatively(P>0.05).There was no significant difference between the two groups in percentage of anterior height of injured vertebra and Cobb angle at 1 week and 6 months postoperatively(P>0.05).Conclusions Percutaneous and multifidus approach pedicle screw fixation for single level thoracolumbar fractures has good clinical effects,but percutaneous pedicle screw fixation has less trauma and faster postoperative recovery.