经皮椎弓根螺钉固定术与传统开放椎弓根螺钉内固定术治疗胸腰椎骨折的近远期疗效

Long-term effect of percutaneous pedicle screw fixation in the treatment of thoracolumbar fractures

目的 探讨经皮椎弓根螺钉固定术与传统开放椎弓根螺钉内固定术治疗胸腰椎骨折的近远期疗效。方法 选取我院2018年6月—2021年6月收治的胸腰椎骨折患者124例,根据手术方案不同分为观察组与对照组,每组各62例。观察组采用微创经皮椎弓根螺钉固定治疗,对照组采用传统开放椎弓根螺钉内固定术治疗。比较两组手术时间、术中出血量、切口长度、住院时间、影像学指标及术后功能恢复情况。结果 与对照组比较,观察组手术时间、术中出血量、切口长度、住院时间均显著降低(P<0.05);两组术后1 d、12个月、24个月伤椎前缘高度均较术前提高,Cobb角均较术前降低(P<0.05);术后1 d,观察组椎前缘高度显著高于对照组,Cobb角显著低于对照组(P<0.05),术后12个月、24个月两组伤椎前缘高度、Cobb角比较差异均无统计学意义(P>0.05)。两组术后6个月、12个月ODI指数均较术前显著降低,且观察组降低程度显著优于对照组(P<0.05)。两组术后1周、6个月、12个月VAS评分均较术前显著降低,其中观察组术后1周VAS评分显著低于对照组(P<0.05)。两组术后并发症总发生率比较差异无统计学意义(P>0.05)。结论 对胸腰椎骨折患者实施经皮椎弓根螺钉固定治疗可降低创伤及疼痛程度,改善腰椎功能,有助于早期康复,远期疗效显著,安全性较高。

Objective To explore long-term effect of percutaneous pedicle screw fixation in the treatment of thoracolumbar fractures.Methods A total of 124 patients with thoracic and lumbar spine fractures admitted to our hospital from June 2018 to June 2020 were selected and divided into observation group and control group with 62 cases each,according to different surgical plans.The observation group was fixed with minimally invasive percutaneous pedicle screw fixation for treatment,and the control group was treated with traditional open pedicle screw internal fixation.The operation time,intraoperative blood loss,incision length,hospital stay,imaging indicators,and postoperative functional recovery were compared between the two groups.Results In terms of perioperative surgery-related indicators,the observation group and the control group were significantly lower(P<0.05).In terms of imaging indicators,the height of the anterior edge of the injured vertebra in the two groups at 1d,12 months,and 24 months after operation was higher than that before operation,and the Cobb angle was lower than that before operation,and the difference was significant(P<0.05).On the first day after the operation,the height of the anterior vertebral edge in the observation group was significantly higher than that in the control group,and the Cobb angle was significantly lower than that in the control group(P<0.05).There was no significant difference in the above indicators between the two groups at 12 months and 24 months after operation(P>0.05).In terms of lumbar spine function,the ODI index of the two groups at 6 and 12 months after surgery was significantly lower than that before the operation,and the degree of reduction in the observation group was significantly better than that of the control group(P<0.05).In terms of pain,the VAS scores of the two groups at 1 week,6 months,and 12 months after surgery were significantly lower than those before surgery,and the VAS score of the observation group was significantly lower than that of the control group at 1 week after surgery(P<0.05).In terms of postoperative complications,there was no significant difference in the total incidence between the two groups(P>0.05).Conclusion Minimally invasive percutaneous pedicle screw fixation for patients with thoracolumbar fractures can achieve satisfactory clinical results.It has the advantages of less trauma and recovery,which can further reduce pain and improve lumbar spine function.The long-term effect is significant and safe.