经皮置钉联合微创经椎弓根植骨治疗胸腰椎骨折的临床疗效

Analysis of the clinical effect of percutaneous pedicle screw fixation combined with transpedicular bone grafting in the treatment of thoracolumbar fracture

目的:探讨经皮置钉联合微创经椎弓根植骨与非植骨治疗胸腰椎骨折患者的临床疗效。方法:自2021年1月至2022年6月,回顾性分析40例胸腰椎骨折患者,其中,试验组26例,男21例,女5例;年龄(47.3±12.3)岁;采用经皮椎弓根置钉联合微创经椎弓根自体骨植骨术。对照组14例,男7例,女7例;年龄(50.2±11.2)岁;采用经皮椎弓根螺钉内固定术。比较两组患者手术时间、术中出血量、术前、术后1周和术后3、12个月伤椎的前缘高度比、伤椎Cobb角、疼痛视觉模拟评分(visual analogue scale,VAS)、改良MacNab评分及术后内植物松动断裂等并发症情况。结果:两组患者手术时间、术中出血量、VAS及前缘高度比较,差异无统计学意义(P>0.05);与术前相比,术后1年VAS及前缘高度百分比均有显著改善(P<0.05)。术前两组伤椎Cobb角比较,差异无统计学意义(P=0.766);术后1周及术后3、12个月两组比较,差异有统计学意义(P<0.05);与术前相比,术后12个月两组伤椎Cobb角均有显著降低(P<0.001)。根据MacNab评分,术后12个月试验组优20例,良5例,可1例;对照组优10例,良3例,可1例,两组比较,差异无统计学意义(P=0.648)。对照组术后第3天出现1例浅表伤口感染,经换药及抗感染治疗后治愈;两组患者术后均无钉棒松动断裂等其他并发症。结论:两种手术方式具有创伤小、疼痛轻、恢复快的优势,均可以恢复伤椎高度、重建脊柱序列,使骨折椎体复位;而伤椎经皮经椎弓根植骨可以增加骨折椎体的稳定性,术后能更好地维持椎体高度,从而降低后凸畸形和钉棒松动断裂等并发症的可能性。

Objective To investigate the clinical efficacy of percutaneous screw fixation combined with minimally invasive transpedicular bone grafting and non-bone grafting in the treatment of thoracolumbar fractures.Methods From Janury 2021 to June 2022,40 patients with thoracolumbar fracture were divided into the experimental group and the control group.There were 26 patients in the experimental group,including 21 males and 5 females with an aberage age of(47.3±12.3)years old,who underwent percutaneous pedicle screw fixation combined with transpedicular autogenous bone grafting.In the control group,14 patients received percutaneous pedicle screw fixation only.including 7 makes and 7 females with an average age of(50.2±11.2)years old.The operative time,intraoperative blood loss,anterior height ratio of injured vertebrae,Cobb angle,visual analogue score(VAS),MacNab scores,loosening or broken of the implants.were compared and analyzed.Results There was no significant difference in operation time,intraoperative blood loss,VAS and anterior height ratio of injured vertebrae between the two groups.Compared with the preoperative results,VAS and anterior height ratio of injured vertebrae were improved statistically(P<0.05).For Cobb angle of injured vertebra,there was no significant difference between the two groups before surgery(P=0.766).While at 1 week,3 months and 12 months after surgery,there were statistically differences between the two groups(P values were 0.042,0.007 and 0.039,respectively).The Cobb angle of injured vertebrae one year after operation was statistically decreased in both groups compared with that before surgery(P<0.001).One year after surgery,the excellent and good rate of Macnab scores was 96.15%in the experimental group and 92.86%in the control group,and there was no statistical differences between the two groups(P=0.648).There was one patient in the control group suffering superficial wound infection on the third day,which was cured by dressing change and anti-infection treatment.There were no postoperative screw loosening and broken in both groups.Conclusion The two surgical methods have the advantages of less trauma,less pain and quicker recovery,which can restore the height of the injured vertebra,reconstruct the spinal sequence and reduce the fracture of the vertebral body.Transpedicular autogenous bone grafting can increase the stability of the fractured vertebra and maintain the height of the vertebra better after surgery,thus reducing the possibility of complications such as kyphosis,screw loosening and broken.