经皮微创椎弓根螺钉内固定术对脊柱骨折的临床疗效分析

Clinical analysis of minimally invasive percutaneous pedicle screw internal fixation for spinal fracture

目的 探讨经皮微创椎弓根螺钉内固定术(minimally invasive cutaneous pedicle screw, MIPPS)在对脊柱骨折的临床疗效。方法 选取2017年10月—2020年5月中国人民解放军联勤保障部队第九八八医院收治,符合纳入标准的脊柱骨折患者88例,根据手术方式分为开放性弓根螺钉内固定术(traditional open pedicle screw, TOPS)组(n=44)和MIPPS组(n=44)。记录两组手术时间、术中出血量、切口长度以及住院时间等围术期指标,采用美国脊髓损伤协会脊髓损伤评分(ASIA)、Oswestry功能障碍指数评分(ODI)分别评估两组患者脊髓神经功能以及胸腰椎能力改善情况,经X线等影像学检查,记录两组Cobb角并计算伤椎椎体压缩率,术后随访1年并记录期间两组并发症发生情况。结果 MIPPS组患者手术时间、术中出血量、切口长度以及住院时间均低于/短于TOPS组(P<0.05);术后两组患者ASIA评分与治疗前比较明显升高,Oswestry评分明显降低,且MIPPS组ASIA评分高于TOPS组,Oswestry评分低于TOPS组(P<0.05);术后两组患者Cobb角与术前比较降低,椎体压缩率升高,且MIPPS组Cobb角低于TOPS组,椎体压缩率高于TOPS组(P<0.05);术后随访2年,MIPPS组并发症发生率为2.27%,低于TOPS组13.64%(P<0.05)。结论 MIPPS治疗胸腰段脊柱骨折患者疗效确切,切口小利于术后恢复,在恢复脊髓神经功能以及改善胸腰椎功能方面具有显著优势,安全可靠。

Objective To investigate the clinical effect of minimally invasive cutaneous pedicle screw(MIPPS)internal fixation on spinal fracture.Methods From October 2017 To May 2020,totally 88 patients with spinal fracture were selected and divided into two groups according to different surgical methods,ToPs group(n=44)and MIPPS group(n=44).Perioperative parameters such as operation time,intraoperative blood loss,incision length and hospital stay were recorded,and American Spinal Cord Injury Association(ASIA)score was used.and Oswestry dysfunction index(ODI)were used to evaluate the improvement of spinal cord function and thoracolumbar function in the two groups.X-ray and other imaging examinations were performed to record the Cobb angle and calculate the vertebral compression rate of the injured vertebra in the two groups.All patients were followed up for 1 year and complications were recorded.Results The operation time,blood loss,incision length and hospital stay in MIPPS group were lower/shorter than those in TOPS group(P<0.05).The ASIA score of MIPPS group was higher than that of TOPS group and the Oswestry score of MIPPS group was lower than that of TOPS group(P<0.05).The Cobb angle of the MIPPS group was lower than that of the TOPS group,and the vertebral compression rate was higher than that of the TOPS group(P<0.05).The complication rate of MIPPS group was 2.27%,which was lower than that of TOPS group(13.64%)(P<0.05).Conclusion MIPPS in the treatment of patients with thoracolumbar spinal fractures is effective,small incision is conducive to postoperative recovery,in the recovery of spinal nerve function and improve the function of thoracolumbar spine has significant advantages,safe and reliable.