后路经皮微创椎弓根螺钉内固定术对脊柱骨折患者创伤应激状态、疼痛及功能恢复的影响

Effect of posterior minimally invasive percutaneous pedicle screw fixation on traumatic stress,pain and functional recovery in patients with spinal fractures

目的:比较后路经皮微创椎弓根螺钉内固定术和传统开放手术对脊柱骨折患者的临床应用价值。方法:按手术方式不同将117例脊柱骨折患者分为传统组(n=52)和微创组(n=65),比较两组患者的手术效果、围术期指标及创伤应激相关指标,并使用视觉模拟评分法(VAS)和功能障碍指数(ODI)评估术前、术后的疼痛及功能恢复情况。结果:术后,两组患者的椎前缘高度百分比高于术前(P<0.05),后凸Cobb角均低于术前(P<0.05),但组间比较差异无统计学意义(P>0.05)。微创组患者的切口长度、手术时间、术中出血量及住院时间均低于传统组(P<0.05)。术后1 d,两组患者的皮质醇(Cor)、C-反应蛋白(CRP)、促肾上腺皮质激素(ACTH)以及肿瘤坏死因子α(TNF-α)均升高(P<0.05),且微创组上述指标均低于传统组(P<0.05)。两组患者的VAS和ODI评分依次为:术后3个月<术后7 d<术前(P<0.05),其中术后7 d微创组患者VAS评分低于传统组(P<0.05)。结论:后路经皮微创椎弓根螺钉内固定术与传统开放手术在治疗脊柱骨折患者中的效果相当,但其手术损伤较小,对患者造成的创伤应激状态更轻,更有利于改善患者术后的疼痛和功能恢复情况。

Objective:To comparatively analyze the clinical application value of posterior minimally invasive percutaneous pedicle screw fixation and traditional open surgery in patients with spinal fractures.Methods:117 patients with spinal fractures were divided into traditional group(n=52)and minimally invasive group(n=65)according to different surgical method.Surgical results,perioperative indicators,and traumatic stress-associated indicators were compared between the two groups.The Visual Analogue Scale(VAS)and Oswestry disability index(ODI)were used to evaluate pain and functional recovery.Results:After surgery,the percentage of anterior vertebral height was significantly increased(P<0.05),and the Cobb angle of kyphosis was significantly reduced(P<0.05),without statistically significant difference between the two groups(P>0.05).The length of incision,operation time,intraoperative blood loss and hospital stay of the minimally invasive group were significantly shorter/lower than those of the traditional group(P<0.05).The levels of cortisol(Cor),C-reactive protein(CRP),adrenocorticotrophic hormone(ACTH)and tumor necrosis factorα(TNF-α)were significantly increased on day 1 after surgery(P<0.05),and these indicators in the minimally invasive group were significantly lower than those in the traditional group(P<0.05).The VAS scores and ODI scores of the two groups were significantly lower at 7 days and 3 months after surgery than before surgery(P<0.05),and significantly lower at 3 months after surgery than 7 days after surgery.(P<0.05).The VAS score of minimally invasive group was lower than that of traditional group at 7 days after surgery(P<0.05).Conclusion:Posterior minimally invasive percutaneous pedicle screw fixation is equivalent to traditional open surgery in the treatment of patients with spinal fractures.However,the former causes less damage and milder traumatic stress,which is more conducive to postoperative pain relief and functional recovery.