长臂单轴椎弓根螺钉与单平面椎弓根螺钉内固定治疗创伤性胸腰椎骨折复位力度比较

Comparison of reduction strength between long-arm single-axis pedicle screw fixation and single-plane pedicle screw fixation in the treatment of traumatic thoracolumbar fractures

背景:经皮入路行长臂单轴椎弓根螺钉固定与微创经皮单平面椎弓根螺钉内固定均是临床常用的经典微创手术方案,但两种术式在治疗胸腰椎骨折方面尚存在争议。目的:对比经皮入路长臂单轴椎弓根螺钉与微创经皮单平面椎弓根螺钉内固定治疗胸腰椎骨折的优势与局限。方法:纳入2017年3月至2021年6月广州中医药大学深圳医院(福田)收治的90例胸腰椎骨折患者,利用随机数表法分对照组(n=45)与试验组(n=45)。对照组进行微创经皮单平面椎弓根螺钉内固定手术,试验组进行经皮入路长臂单轴椎弓根螺钉内固定手术,对比两组围术期一般情况、疼痛程度、恢复情况相关指标及并发症。结果与结论:①与对照组相比,试验组术中失血量较少、手术时间及住院时间缩短(P<0.05);②术后2周、1个月,试验组Oswestry功能障碍指数、Cobb角均低于对照组(P<0.05),伤椎前缘高度与后缘高度大于对照组(P<0.05);术后2个月,试验组Oswestry功能障碍指数、Cobb角均低于对照组(P<0.05),两组间伤椎前缘高度与后缘高度比较差异无显著性意义(P>0.05);术后2周,试验组目测类比评分低于对照组(P<0.05);③对照组45例中发生切口感染2例、运动障碍2例、植入物相关不良反应1例,总发生率为11%;试验组45例中发生运动障碍2例,总发生率为4%,两组间并发症总发生率比较差异无显著性意义(P>0.05);④结果显示,经皮入路长臂单轴椎弓根螺钉与微创经皮单平面椎弓根螺钉内固定治疗胸腰椎骨折均可取得较好效果,但经皮入路长臂单轴椎弓根螺钉内固定手术时间较短、术中失血量少,故在获取同等效益情况下其是理想术式选择。

BACKGROUND:Percutaneous long-arm single-axis pedicle screw fixation and minimally invasive percutaneous single-plane pedicle screw internal fixation are both classical minimally invasive surgical options commonly used in clinical practice,but the two surgical methods in the treatment of thoracolumbar fractures are still controversial.OBJECTIVE:To compare the advantages and limitations of two procedures,long-arm single-axis pedicle screw percutaneous approach and minimally invasive percutaneous single-plane pedicle screw internal fixation,in the treatment of thoracolumbar fractures.METHODS:Ninety patients with thoracolumbar fractures admitted to Shenzhen Hospital of Guangzhou University of Chinese Medicine from March 2017 to June 2021 were included and assigned to the control group(n=45)and the trial group(n=45).The control group received minimally invasive percutaneous single-plane pedicle screw internal fixation.The trial group received long-arm single-axis pedicle screw percutaneous approach.The indexes related to perioperative general condition,pain level,and recovery were compared between the two groups.RESULTS AND CONCLUSION:(1)Compared with the control group,the trial group had less intraoperative blood loss,shorter operative time and hospital stay(P<0.05).(2)At 2 weeks and 1 month after operation,Oswestry dysfunction index score and Cobb angle in the trial group were lower than those in the control group(P<0.05).The anterior and posterior heights of the injured vertebra were higher in the trial group than those of the control group(P<0.05).At 2 months after operation,the Oswestry dysfunction index score and Cobb angle in the trial group were lower than those in the control group(P<0.05).There was no significant difference in the anterior and posterior heights of the injured vertebra between the two groups(P>0.05).At 2 weeks after operation,the visual analog scale score was lower in the trial group than that in the control group(P<0.05).(3)Among the 45 cases in the control group,there were 2 cases of incision infection,2 cases of dyskinesia,and 1 case of implant-related adverse reactions,with a total incidence rate of 11%.Among the 45 cases in the trial group,there were 2 cases of dyskinesia,and the total incidence was 4%.There was no significant difference in the total incidence of complications between the two groups(P>0.05).(4)Both long-arm single-axis pedicle screw percutaneous approach and minimally invasive percutaneous single-plane pedicle screw internal fixation can achieve better results in the treatment of thoracolumbar fractures.However,the former has shorter operative time and less intraoperative blood loss,so the former is the ideal surgical option for obtaining the same benefit.