经皮和开放经肌间隙椎弓根螺钉非融合固定治疗无神经功能障碍A_(3)/A_(4)型胸腰椎骨折的疗效比较

Comparison of Therapeutic Effects between Percutaneous and Open Intramuscular Pedicle Screw Non Fusion Fixation for the Treatment of A_(3)/A_(4)Type Thoracolumbar Fractures without Neurological Dysfunction

【目的】探讨经皮和开放经肌间隙椎弓根螺钉非融合固定治疗无神经功能障碍的A_(3)/A_(4)型胸腰椎骨折的临床疗效。【方法】采用前瞻性队列研究设计,选取2018年1月至2020年12月联勤保障部队第九〇〇医院收治的46例无神经功能障碍A_(3)/A_(4)型胸腰椎骨折患者,将患者随机交替纳入经皮椎弓根螺钉固定(transmuscular space screwfixation,PPSF)组和切开经肌间隙椎弓根螺钉固定(Open transmuscular space pedicle screwfixation,OPSF)组。比较两组手术前后Cobb角、12个月后的矫正角丢失、失血量、手术时间、累积辐射时间。【结果】OPSF组和PPSF组手术前后Cobb角以及12个月后的矫正角丢失比较,差异无统计学意义(P>0.05)。与OPSF组比较,PPSF组手术时间更短,围术期失血量也更少,平均累积辐射时间更长,差异均有统计学意义(P<0.05)。【结论】经皮和切开经肌间隙椎弓根螺钉固定治疗无神经功能障碍A_(3)/A_(4)型胸腰椎骨折疗效相当,但经皮椎弓根螺钉固定手术时间更短,失血量也更少,但平均累积辐射时间更长。

【Objective】To explore the clinical efficacy of percutaneous and open intramuscular pedicle screw non fusion fixation in the treatment of A_(3)/A_(4)type thoracolumbar fractures without neurological dysfunction.【Methods】A prospective Cohort study design was used to select 46 patients with A_(3)/A_(4)thoracolumbar fractures without neurological dysfunction who were admitted to The 900th Hospital of Joint Logistics Support Force from January 2018 to December 2020.The patients were randomly and alternately included in the transmuscular space screwfixation(PPSF)group and the open transmuscular space pedicle screwfixation(OPSF)group.The Cobb angle before and after surgery,corrected loss,blood loss,surgical time,and cumulative radiation time after 12 months were compared between two groups.【Results】There was no statistically significant difference in Cobb angle before and after surgery and correction loss after 12 months between the OPSF group and the PPSF group(P>0.05).Compared with the OPSF group,the PPSF group had shorter surgical time,less perioperative blood loss,and higher average cumulative radiation time,with statistically significant differences(P<0.05).【Conclusion】The efficacy of percutaneous and open intramuscular pedicle screw fixation in the treatment of A_(3)/A_(4)type thoracolumbar fractures without neurological dysfunction is equivalent,but pedicle screw fixation has shorter surgical time,less blood loss,and higher average cumulative radiation time.