开放与经皮椎弓根螺钉内固定治疗单纯胸腰椎椎体骨折的对比研究

Comparison of Efficacy for Open and Percutaneous Pedicle Screw Fixation in the Treatment of Simple Thoracolumbar Vertebral Body Fractures

目的对比后路开放与经皮椎弓根螺钉内固定治疗单节段无神经症状胸腰椎椎体骨折的临床疗效。方法前瞻性分析黄山市人民医院脊柱外科2018年8月至2020年11月收治的32例胸腰椎骨折患者,其中男18例,女14例;年龄33~72岁,平均年龄(53.56±9.48)岁。将32例胸腰椎骨折患者随机分为经皮组和开放组,每组16例。经皮组采用微创经皮椎弓根螺钉内固定术,开放组采用开放椎弓根螺钉内固定术。对比两组患者手术时间、术中失血量、术后住院时间、切口长度,术前与术后1 d、3 d疼痛视觉模拟评分(visual analogue scale,VAS),术前与术后3 d、末次随访时椎体前后缘高度比值(%)及后凸Cobb角。结果所有患者随访6~12个月,平均随访(9.20±2.14)个月。经皮组与开放组基线资料,术前、术后3 d、末次随访时组间椎体前后缘高度比值(%)及后凸Cobb角比较,差异均无统计学意义(P>0.05)。经皮组术后1 d VAS较开放组稍高,但差异无统计学意义(P>0.05)。两组患者组内术后各时间段椎体前后缘高度比值(%)、后凸Cobb角与术前相比均明显改善(P<0.05)。经皮组术中失血量少,手术时间、术后住院时间短,切口长度小且术后3dVAS更低,与开放组相比差异均具有统计学意义(P<0.05)。结论微创经皮椎弓根螺钉内固定与开放椎弓根螺钉内固定治疗胸腰椎椎体骨折疗效相当,但经皮组具有术中失血量少、手术时间及术后住院时间短、创伤小、VAS更低的优势。

Objective To compare the clinical efficacy of posterior open and percutaneous pedicle screw fixation in the treatment of single segment asymptomatic thoracolumbar vertebral body fractures.Methods From August 2018 to November 2020,32 patients with thoracolumbar vertebral body fractures including 18 males and 14 females with an average age of(53.56±9.48)were randomly divided into open group(n=16)and percutaneous group(n=16).The percutaneous group was treated with minimally invasive percutaneous pedicle screw fixation,and the open group was treated with open pedicle screw fixation.The operation time,intraoperative blood loss,postoperative hospital stay,incision length,visual analogue score(VAS)before and after surgery,the ratio of anterior and posterior vertebral height(%)and kyphosis Cobb angle at the last follow-up were compared between the two groups.Results All patients were followed up for 6~12 months,with an average follow-up of(9.20±2.14)months.There were no significant differences in baseline data,ratio of anterior and posterior vertebral height(%)and kyphosis Cobb angle between the two groups(P>0.05).The VAS score of the percutaneous group was slightly higher than that of the open group on the first day after operation,but the difference was not statistically significant(P>0.05).The ratio of anterior and posterior vertebral height(%)and kyphosis Cobb angle in two groups were significantly improved postoperation(P<0.05).The minimally invasive group had less intraoperative blood loss,shorter operation time,shorter postoperative hospital stay,shorter incision length,lower VAS score on the third day after operation and the differences were statistically significant compared with the open group(P<0.05).Conclusion Minimally invasive percutaneous pedicle screw fixation and open pedicle screw fixation in the treatment of thoracolumbar vertebral body fractures have the same curative effect,but the percutaneous group has the advantages of less blood loss,shorter operation time and postoperative hospital stay,less trauma and lower VAS.