经皮椎弓根螺钉内固定术与小切口Wiltse入路椎弓根螺钉内固定术治疗胸腰椎骨折的短期疗效比较

Short-term clinical efficacy of percutaneous pedicle screw fixation versus minimal-incision Wiltse approach in the treatment of thoracolumbar fractures

目的对比研究经皮椎弓根螺钉内固定术(PPS)与小切口Wiltse入路椎弓根螺钉内固定术(MWPS)治疗胸腰椎骨折的短期临床效果。方法回顾性分析2018年2月—2020年2月四川省人民医院金牛医院骨一科收治的86例单节段胸腰椎骨折患者的临床资料,根据术式不同分为PPS组(41例)和MWPS组(45例)。PPS组男性22例,女性19例;年龄18~70岁,平均48.9岁。致伤原因高处坠落伤12例,道路交通伤25例,重物砸伤4例。MWPS组男性27例,女性18例;年龄18~70岁,平均49.0岁;致伤原因高处坠落伤11例,道路交通伤28例,重物砸伤6例。比较两组患者的手术时间、术中出血量、术中透视时间、术后疼痛情况以及术后1个月Cobb角纠正程度、椎体高度恢复程度以及椎体复位情况。结果MWPS组手术时间和术中透视时间分别为(73.58±5.73)min、(66.36±12.78)s,均明显少于PPS组(85.74±5.82)min、(312.69±11.92)s,P<0.01;两组术中出血量分别为(68.62±3.63)mL、(69.65±3.72)mL,差异无统计学意义(P>0.05);MWPS组术后24h、7d、14d和1个月视觉模拟评分(VAS)明显低于PPS组(5.8±0.7)分vs.(6.1±0.6)分、(3.3±0.7)分vs.(4.2±0.8)分、(2.1±0.1)分vs.(2.9±0.3)分、(1.1±0.1)分vs.(1.9±0.2)分,P<0.05;MWPS组置钉准确率和术后椎体复位率明显高于PPS组(91.85%vs.80.49%、88.89%vs.70.73%),P<0.05;MWPS组术后1个月椎体高度恢复程度和术后1个月Cobb角纠正程度均高于PPS组(98.87±11.57)%vs.(97.58±11.65)%、(85.17±8.63)%vs.(82.91±8.87)%,但差异无统计学意义(P>0.05)。结论PPS与MWPS治疗胸腰椎骨折均具有良好的短期临床效果,但MWPS具有更高的置钉准确率和椎体复位率以及更低的辐射量,更能有效缓解患者术后的疼痛程度。

Objective To compare the short-term clinical effects of percutaneous pedicle screw internal fixation(PPS)and minimal-incision Wiltse approach pedicle screw internal fixation(MWPS)in the treatment of thoracolumbar fractures.Methods A retrospective analysis was performed on the clinical data of 86 patients with single-level thoracolumbar fracture admitted to the Department of Orthopedics of our hospital from Feb.2018 to Feb.2020,and they were divided into PPS group(n=41)and MWPS group(n=45)according to surgical procedures.There were 22 males and 19 females in PPS group.The age ranged from 18 to 70 years,with an average of 48.9 years.The causes of injuries were:12 cases of falling from high places,25 cases of road traffic injuries,4 cases of heavy objects.In MWPS group,there were 27 males and 18 females.The age ranged from 18 to 70 years,with an average of 49.0 years.The causes of injuries were:11 cases of falling from high places,28 cases of road traffic injuries and 6 cases of heavy crushing injuries.The operation time,intraoperative blood loss,intraoperative fluoroscopic time,postoperative pain,correction degree of Cobb angle,recovery degree of vertebral height and vertebral reduction were compared between the two groups.Results The operative time and intraoperative fluoroscopy time of MWPS group were(73.58±5.73)minutes and(66.36±12.78)seconds,respectively,which were significantly shorter than those of PPS group[(85.74±5.82)minutes and(312.69±11.92)seconds,P<0.01].The intraoperative blood loss of the two groups was(68.62±3.63)mL and(69.65±3.72)mL,respectively,and the difference was not statistically significant(P>0.05).The visual analog scale(VAS)of MWPS group were significantly lower than those of PPS group at 24 hours,7 days,14 days and 1 month after surgery[(5.8±0.7)points vs.(6.1±0.6)points,(3.3±0.7)points vs.(4.2±0.8)points,(2.1±0.1)points vs.(2.9±0.3)points,(1.1±0.1)points vs.(1.9±0.2)points],P<0.05.The accuracy of screw placement and postoperative vertebral reduction in MWPS group was significantly higher than that in PPS group(91.85%vs.80.49%,88.89%vs.70.73%),P<0.05.The degree of vertebral height recovery and Cobb angle correction in MWPS group were better than those in PPS group[(98.87±11.57)%vs.(97.58±11.65)%,(85.17±8.63)%vs.(82.91±8.87)%,P>0.05].Conclusion Both PPS and MWPS have good clinical effects in the treatment of thoracolumbar fracture.Compared with PPS,MWPS has higher accuracy of nail placement,lower rate of vertebral reduction and lower dose of radiation,which can effectively relieve postoperative pain of patients.