经皮椎弓根钉微创手术与开放式椎弓根螺钉内固定术治疗脊柱骨折的有效性对比

Comparison of the Effectiveness of Minimally Invasive Percutaneous Pedicle Screw and Open Pedicle Screw Internal Fixation in the Treatment of Spinal Fractures

目的:比较经皮椎弓根钉微创手术与开放式椎弓根螺钉内固定术治疗脊柱骨折的有效性。方法:选取2019年12月-2020年12月江西省中西医结合医院收治的142例脊柱骨折患者进行研究,按照随机数字表法将患者分为对照组(n=71)和研究组(n=71),对照组进行开放式椎弓根螺钉内固定术治疗,研究组进行经皮椎弓根钉微创手术治疗。比较两组术后3个月的临床疗效、影像学指标、临床相关指标及恢复情况和术后1、2 d的血清肌酸激酶活性。结果:术后3个月,研究组临床总有效率、伤椎前缘高度比及矢状面指数均高于对照组,后凸Cobb’s角小于对照组,差异均有统计学意义(P<0.05)。与对照组相比,研究组恢复正常活动时间及住院时间均较短,术中出血量较少,差异均有统计学意义(P<0.05);研究组的手术时间虽长于对照组,但两组比较差异无统计学意义(P>0.05)。术后3个月,研究组的VAS评分及ODI评分均低于对照组,差异均有统计学意义(P<0.05)。术后3个月,研究组的颈椎和腰椎JOA评分均高于对照组,差异均有统计学意义(P<0.05)。术后1、2 d,研究组血清肌酸激酶活性均低于对照组,差异均有统计学意义(P<0.05)。结论:脊柱骨折患者应用经皮椎弓根钉微创手术治疗效果明显,可减轻疼痛程度,改善脊柱功能,值得推广。

Objective:To compare the efficacy of minimally invasive percutaneous pedicle screw and open pedicle screw internal fixation in the treatment of spinal fractures.Method:A total of 142 patients with spinal fracture admitted to our hospital from December 2019 to December 2020 were selected for this study.According to the random number table method,the patients were divided into control group(n=71)and study group(n=71).The control group received open pedicle screw internal fixation,and the study group received percutaneous pedicle screw minimally invasive surgical treatment.Clinical efficacy,imaging indexes,clinically related indexes and recovery at 3 months after surgery,and serum creatine kinase activity at 1 and 2 d after surgery were compared between the two groups.Result:3 months after operation,the clinical total effective rate,anterior edge height ratio of injured vertebra and sagittal plane index in the study group were higher than those in the control group,while the Cobb’s angle of posterior convex in the study group was lower than that in the control group,the differences were statistically significant(P<0.05).Compared with the control group,the study group had shorter time to return to normal activity and hospital stay,and less intraoperative blood loss,the differences were statistically significant(P<0.05);although the operation time of the study group was longer than that of the control group,but the difference between the two groups was not statistically significant(P>0.05).3 months after surgery,the VAS score and ODI score in the study group were both lower than those of the control group,the differences were statistically significant(P<0.05).3 months after surgery,the JOA scores of cervical spine and lumbar spine in the study group were higher than those in the control group,the differences were statistically significant(P<0.05).1 and 2 d after operation,serum creatine kinase activity in the study group were lower than those in the control group,the differences were statistically significant(P<0.05).Conclusion:Minimally invasive percutaneous pedicle screw surgery is effective in the treatment of spinal fracture,which can reduce the degree of pain and improve the spinal function.