经肌间隙椎弓根螺钉内固术和经皮椎弓根螺钉内固定术治疗胸腰椎骨折的疗效及安全性分析

Analysis of efficacy and safety of mini-open Wiltse approach with pedicle screw fixation and percutaneous pedicle screw fixation in the treatment of thoracolumbar fractures

目的:比较经皮椎弓根螺钉内固定术(PPSF)及经肌间隙椎弓根螺钉内固定术(MWPSF)治疗胸腰椎骨折的疗效。方法:回顾性分析60例MWPSF组(经肌间隙入路)和51例PPSF组(经皮入路)临床资料,比较两组患者术前、术后24 h、术后3个月及6个月时的伤椎疼痛状态、影像学指标及功能恢复情况;记录术后并发症。结果:MWPSF组患者切口长度、术中出血量高于PPSF组,手术时间、术中透视时间少于PPSF组(P<0.05);术后24 h,MWPSF组患者的VAS评分低于PPSF组(P<0.05);两组术前、术后24 h、术后3个月及6个月时的后凸Cobb角呈逐渐下降趋势,伤椎前缘高度比呈逐渐升高趋势(P<0.05),但组间不同时间点比较,差异无统计学意义(P>0.05);MWPSF组椎弓根螺钉置入准确率(96.20%)与PPSF组(94.20%)比较,差异无统计学意义(P>0.05);MWPSF组术后3个月的ODI指数低于PPSF组(P<0.05);两组随访时PPSF组创口感染及残留腰背疼痛发生率比较,差异无统计学意义(P>0.05)。结论:MWPSF治疗胸腰椎骨折的手术时间短,术中透视时间少,值得在临床推广。

Objective:To compare the efficacy of percutaneous pedicle screw fixation(PPSF)and mini-open Wiltse approach with pedicle screw fixation(MWPSF)in treating thoracolumbar fractures.Methods:The clinical data of 111 patients were retrospectively analyzed,and the patients were divided into MWPSF group(mini-open Wiltse approach,n=60)and PPSF group(percutaneous approach,n=51).The perioperative indicators as well as pain status,imaging indicators and functional recovery of injured vertebra before surgery and at 24 hours,3 months and 6 months after surgery were compared,and the postoperative complications were recorded.Results:The incision length and intraoperative blood loss in MWPSF group were longer or more,and the surgical time and intraoperative fluoroscopy time were shorter compared to PPSF group(P<0.05).The VAS score of MWPSF group at 24 hours after surgery was lower than that of PPSF group(P<0.05).The kyphosis Cobb angle showed a gradual downward trend before surgery and at 24 hours,3 months and 6 months after surgery within the two groups,and the height ratio of the injured vertebral front edge showed a gradual upward trend(P<0.05),there were no statistical differences between the groups at different time points(P>0.05).The accuracy rate of pedicle screw placement in MWPSF group(96.20%)was not significantly different from(94.20%)in PPSF group(P>0.05).The ODI index at 3 months after surgery in MWPSF group was lower than that in PPSF group(P<0.05).There was no significant difference in the incidence rate of wound infection and residual low back pain between the two groups during follow-up(P>0.05).Conclusion:MWPSF has a short surgical time and short intraoperative fluoroscopy time,which is worthy of clinical promotion.