微创与开放椎弓钉固定胸腰椎骨折的比较

Minimally invasive percutaneous pedicle screw fixation versus open counterpart for thoracolumbar fractures

[目的]比较微创经皮置钉与开放椎弓根螺钉固定胸腰椎骨折的疗效。[方法]2018年10月一2019年4月手术治疗胸腰椎骨折不伴神经损伤患者64例。其中,32例采用微创经皮置钉术(微创组),32例采用常规开放椎弓根螺钉内固定(开放组)。比较两组临床与影像资料。[结果]两组均顺利完成手术,无严重并发症。微创组手术时间显著长于开放组(P<0.05),但微创组术中出血量显著少于开放组(P<0.05)。随时间推移,两组患者VAS评分均显著下降(P<0.05)。术后2周、5个月和末次随访时,微创组的VAS评分显著低于开放组(P<0.05)。影像方面,与术前相比,末次随访时两组患者椎体压缩率和局部后凸Cobb角均显著改善(P<0.05)。[结论]微创经皮置钉与传统开放椎弓根螺钉内固定均能有效治疗胸腰椎骨折,相比之下,微创经皮置钉手术创伤小。

[Objective]To compare the clinical outcomes of minimally invasive percutaneous pedicle screw fixation(PPF)versus conventional open pedicle screw fixation(OPF)for thoracolumbar fractures.[Method]From October 2018 to April 2019,a total of 64 patients underwent surgical treatment for thoracolumbar fractures without nerve injury in our department.Of them,32 patients received PPF,while the remaining 32 patients underwent OPF.The clinical and radiographic documents were compared between the two groups.[Results]The patients in both groups had operation performed successfully without serious complications.Although the PPF group consumed significantly longer operation time than the OPF group(P<0.05),the former had significantly less blood loss intraoperatively than the latter(P<0.05).The VAS score decreased significantly in both groups over time(P<0.05),which in the PPF group proved significantly superior to that in the OPF group at 2 weeks,5 months,and the latest follow-up(P<0.05).In terms of imaging evaluation,the vertebral compression rate and local kyphotic Cobb angle improved significantly in both groups at the latest follow up compared with those preoperatively(P<0.05).[Conclusion]Both PPF and OPF is effective for treatment of thoracolumbar fractures.By comparison,the PPF has advantage of considerably less iatrogenic trauma.