微创椎弓根钉内固定对胸腰椎创伤性骨折患者Cobb'角、椎体前缘高度的影响

Effect of minimally invasive pedicle screw fixation on Cobb′s angle and anterior vertebral height in patients with traumatic thoracolumbar spinal fractures

目的探讨微创椎弓根钉内固定对胸腰椎创伤性骨折(TTSF)患者Cobb′角、椎体前缘高度的影响。方法选取2017年8月至2019年12月在大连市第二人民医院治疗的80例TTSF患者,按手术方案的不同分为对照组与研究组,每组各40例。对照组采用传统开放式椎弓根螺钉内固定治疗,研究组采用微创椎弓根钉内固定治疗。比较两组的Cobb′角、椎体前缘高度,比较两组的临床指标、视觉模拟评分法(VAS)评分、腰椎功能及术后并发症发生情况。结果术前两组的椎体Cobb′角及椎体前缘高度比较,差异无统计学意义(P>0.05);术后6个月,两组的椎体Cobb′角小于术前,椎体前缘高度大于术前,差异均有统计学意义(P<0.05),但两组比较,差异无统计学意义(P>0.05)。研究组的手术时间、住院时间短于对照组,手术切口短于对照组,术中失血量及引流量少于对照组,差异均有统计学意义(P<0.05)。两组术前的VAS评分及腰椎功能JOA评分比较,差异无统计学意义(P>0.05);术后1周及术后2个月,两组的VAS评分低于术前,腰椎功能JOA评分高于术前;且研究组的VAS评分低于对照组,腰椎功能JOA评分高于对照,差异均有统计学意义(P<0.05)。研究组的术后切口感染、内固定移位、骨不连、血管神经损伤总发生率为7.5%,低于对照组的32.5%,差异有统计学意义(P<0.05)。结论TTSF采用微创椎弓根钉内固定治疗,可有效改善后凸Cobb′角及椎体前缘高度水平,提升临床指标,促进腰椎功能恢复及降低术后并发症发生率,值得临床推广应用。

Objective To investigate the effect of minimally invasive pedicle screw fixation(MIPSF)on Cobb′s angle and anterior vertebral height(AVH)in patients with traumatic thoracolumbar spinal fractures(TTSF).Methods A total of 80 patients with TTSF treated in Dalian Second People′s Hospital from August 2017 to December 2019 were selected,the patients were divided into the control and the study group according to different surgical procedures,40 cases in each group.Patients in the control group were treated with traditional open pedicle screw fixation,while patients in the study group were treated with MIPSF.Cobb′s angle,AVH,clinical indicators,visual analogue scale(VAS)score,lumbar function and postoperative complications were compared between the two groups.Results There were no significant differences in the Cobb′s angle or AVH between the two groups before surgery(P>0.05).At 6 months after surgery,the Cobb′s angle of the two groups were less than before surgery,AVH of the two groups were greater than before surgery,the differences were statistically significant(P<0.05);but there were no significant differences between the two groups(P>0.05).The operative time and hospital stay of the study group were shorter than those of the control group,the length of surgical incision of the study group was shorter than that of the control group,the amount of blood loss and the volume of drainage in the study group were less than that in the control group,the differences were statistically significant(P<0.05).There were no significant differences in VAS score and Japanese Orthopedic Association(JOA)score of lumbar function between the two groups before surgery(P>0.05).At one week and two months after surgery,and the VAS score were lower than before surgery,lumbar spine function JOA score were higher than before surgery,VAS score in the study group was lower than that in the control group,and JOA score in the study group was higher than that in the control group,the differences were statistically significant(P<0.05).The total incidence of surgical incision infection,internal fixation displacement,bone nonunion and vascular and nerve injury in the study group was 7.5%,lower than that of the control group accounting for 32.5%,the difference was statistically significant(P<0.05).Conclusion MIPSF for TTSF can effectively improve the reducing Cobb′s angle and AVH,improve the clinical indicators,promote the functional recovery of the lumbar spine and reduce postoperative complications,and is worthy of clinical promotion and application.