不同手术方式治疗胸腰椎骨折患者的效果

Effects of Different Surgical Methods on Patients with Thoracolumbar Fractures

目的:对比不同手术方式(经肌间隙椎弓根螺钉内固定术vs.传统后正中椎弓根螺钉内固定术)治疗胸腰椎骨折患者的效果。方法:回顾性分析九江市第一人民医院骨科于2013年1月-2021年1月收治的54例胸腰椎骨折患者临床资料,按照手术方式的不同分为传统组和试验组,传统组(n=27)给予传统后正中椎弓根螺钉内固定术治疗,试验组(n=27)给予经肌间隙椎弓根螺钉内固定术治疗。比较两组术中术后指标、血清乳酸脱氢酶(LDH)水平、肌酸激酶(CK)水平、伤椎后凸Cobb角、椎体前缘高度比值及术后并发症发生情况。结果:试验组手术时间及住院时间均短于传统组、术中出血量及术后引流量均少于传统组,差异均有统计学意义(P<0.05);两组术后3 d的LDH、CK均高于本组术前,试验组均低于传统组,差异均有统计学意义(P<0.05);两组术后3个月的后凸Cobb角、椎体前缘高度比值与本组术前对比,差异均有统计学意义(P<0.05);试验组并发症发生率为7.41%,低于传统组的33.33%(P<0.05)。结论:两种术式均能有效地改善患者的后凸Cobb角、椎体前缘高度比值,经肌间隙椎弓根螺钉内固定术的手术时间更短,术中出血量更少,损伤更小,安全性更高,值得推广。

Objective:To compare the efficacy of different surgical methods(transintermuscular pedicle screw fixation vs.traditional posterior median pedicle screw fixation) in the treatment of thoracolumbar fracture.Method:Retrospective analysis was performed on the clinical data of 54 patients with thoracolumbar fracture admitted to the Department of Orthopedics of Jiujiang NO.1 People’s Hospital from January 2013 to January 2021.According to the different surgical methods,they were divided into the traditional group and the experimental group.Traditional group(n=27) received traditional posterior median pedicle screw internal fixation,experimental group(n=27) received intermuscular pedicle screw internal fixation.Intraoperative and postoperative indexes,serum lactate dehydrogenase(LDH) level,creatine kinase(CK) level,Cobb angle,vertebral anterior edge height ratio and postoperative complications of the two groups were compared.Result:The operation time and hospitalization time of the experimental group were shorter than those of the traditional group,intraoperative blood loss and postoperative drainage of the experimental group were significantly less than those of the traditional group,the differences were statistically significant(P<0.05);the levels of LDH and CK of the two groups at 3 days after operation were higher than those before operation,and those of the experimental group were lower than those of the traditional group(P<0.05);there were significant differences in the kyphotic Cobb angle and the ratio of the height of the anterior edge of the vertebral body between the two groups 3 months after operation and before operation(P<0.05);the complication rate of the experimental group was 7.41%,which was lower than 33.33% in the traditional group(P<0.05).Conclusion:Both intramuscular pedicle screw internal fixation and traditional posterior median pedicle screw internal fixation can effectively improve the kyphotic Cobb angle and the ratio of the height of the anterior edge of the vertebral body,but transintermuscular pedicle screw fixation has shorter operation time,less intraoperative bleeding,less damage to patients and higher safety,which is worthy of promotion.