经皮椎弓根螺钉技术治疗胸腰椎骨折共平面置钉导向器设计与临床应用

Design and clinical application of coplanar screw guide for percutaneous pedicle screw in the treatment of thoracolumbar fracture

背景:经皮椎弓根螺钉内固定是临床上治疗椎体骨折的常用微创手术,该手术的关键步骤是穿刺定位和准确置钉,对患者术后恢复至关重要。目的:设计一种用于微创经皮椎弓根螺钉内固定术的共平面置钉导向器,并观察它在胸腰椎骨折临床治疗中的应用价值。方法:以拟采用微创经皮椎弓根螺钉内固定治疗的60例胸腰椎骨折患者为研究对象,随机分为2组,每组30例。对照组采用传统的置钉技术;研究组采用共平面置钉导向器辅助置钉技术,比较两组的置钉与手术情况、近期矫形与复位效果以及远期功能恢复和生活质量。结果与结论:①两组患者术后引流量、术中失血量、住院时间、骨折愈合时间及矫正率的差异均无显著性意义(P>0.05);与对照组比较,研究组手术时间短、术中透视次数少,置钉共平面率高(均P<0.05);②术后两组患者的目测类比评分均较术前降低,且研究组术后1,3,6个月的疼痛评分均低于对照组(P<0.05);③至末次随访时,研究组伤椎前缘高度比、Cobb角及ODI评分改善率高于对照组(P<0.05),丢失率低于对照组(P<0.05);④结果说明,自制的共平面置钉导向器应用于微创经皮椎弓根螺钉置钉技术治疗胸腰椎骨折,在缩短手术时间、提高螺钉置入准确率、减少放射线暴露和缓解疼痛等方面具有优势,利于提高远期生活质量。

BACKGROUND:Percutaneous pedicle screw internal fixation is a common minimally invasive operation for clinical treatment of vertebral fractures.The key steps of this operation are puncture positioning and accurate screw placement,which are of great importance for postoperative recovery of patients.OBJECTIVE:To design a coplanar screw placement guide for minimally invasive percutaneous pedicle screw internal fixation,and to observe its clinical value in the treatment of thoracolumbar fractures.METHODS:Totally 60 patients with thoracolumbar fracture treated by minimally invasive percutaneous pedicle screw internal fixation were randomly divided into two groups,with 30 cases in each group.The control group was treated with traditional screw placement technique,and the study group was treated with coplanar screw placement guide assisted screw placement.The screw placement and operation,recent orthopedical and reduction effects,long-term functional recovery and quality of life were compared between the two groups.RESULTS AND CONCLUSION:(1)There were no significant differences in postoperative drainage volume,intraoperative blood loss,hospital stay,fracture healing time,or correction rate between the two groups(P>0.05).The study group got shorter operation time,fewer intraoperative fluoroscopy times,and higher coplanar rate compared with the control group(all P<0.05).(2)Visual analogue scale scores in both groups were lower than those before surgery,and the pain scores in the study group at 1,3 and 6 months after surgery were lower than those in the control group(P<0.05).(3)At the last follow-up,the anterior edge height ratio,Cobb angle and ODI score of the study group were higher than those of the control group(P<0.05),while the loss rate of the study group was lower than that of the control group(P<0.05).(4)It is concluded that the self-made coplanar screw placement guide used in minimally invasive percutaneous pedicle screw technique in the treatment of thoracolumbar fracture has advantages in shortening the operation time,improving the accuracy of screw implantation,reducing radiation leakage and relieving pain,which is benefit for improving long-term quality of life.