不同入路椎弓根钉内固定术对创伤性腰椎骨折患者术后腰痛及恢复情况的影响

Effect of different Approaches of pedicle Screw internal Fixation on postoperative Waist Pain and Recovery in Patients with traumatic Lumbar Fractures

目的分析不同入路椎弓根钉内固定术对创伤性腰椎骨折患者术后腰痛及恢复情况的影响。方法选择2021年3月至2023年3月新野县第二人民医院收治的100例创伤性腰椎骨折患者,按随机数字表法分为经皮入路组与经椎旁肌间隙入路组各50例。比较两组围术期相关指标;分别于术前、术后3个月时测量后凸Cobb角、伤椎前缘高度及腰椎功能、疼痛水平;记录并比较术后两组并发症发生的情况。结果经皮入路组切口长度相较经椎旁肌间隙组短,术中出血量相较经椎旁肌间隙入路组少,术中手术时长、术中透视次数、住院时间相较经椎旁肌间隙入路组多,差异有统计学意义(P<0.05);术后3个月,两组后凸Cobb角、伤椎前缘高度相较术前低,差异均有统计学意义(P<0.05),但两组之间比较差异无统计学意义(P>0.05);术后3个月,两组患者Oswestry功能障碍指数问卷表(ODI)评分、视觉模拟评分法(VAS)评分相较术前低,差异有统计学意义(P<0.05),但两组之间比较差异无统计学意义(P>0.05);术后经皮入路组出现并发症相较经椎旁肌间隙入路组低,但两组之间比较差异无统计学意义(P>0.05)。结论两种入路方式均可有效治疗创伤性腰椎骨折患者,可改善患者腰痛及功能障碍,其经皮入路具有手术切口较小,术中出血量少的优势,而经椎旁肌间隙入路则可有效缩短患者住院时间,临床可根据患者病情选择合适的手术方式。

Objective To analyze the effects of different approaches of pedicle screw internal fixation on postoperative waist pain and recovery in patients with traumatic lumbar fractures.Methods A total of 100 patients with traumatic lumbar fractures admitted to the Second People's Hospital of Xinye County from March 2021 to March 2023 were randomly divided into percutaneous approach group and the paravertebral muscular interspace approach group using a random number table method,with 50 patients in each group.The perioperative related indicators between two groups were compared;The Cobb angle of kyphosis,anterior edge height of the injured vertebra,lumbar spine function,and pain level were measured before and 3 months after surgery;The incidence of postoperative complications were recorded and compared between the two groups.Results The incision length of the percutaneous approach group was shorter than that of the paravertebral muscular interspace approach group,and the intraoperative bleeding was less than that of the paravertebral muscular interspace approach group,the intraoperative surgery time,intraoperative fluoroscopy frequency,and hospitalization time were more than those of the paravertebral muscular interspace approach group,and the difference was statistically significant(P<0.05);Three months after surgery,the Cobb angle of the posterior convexity and the height of the anterior edge of the injured vertebra in both groups were lower than those before surgery,and the differences were statistically significant(P<0.05),but there was no statistically significant difference between the two groups(P>0.05);Three months after surgery,the Oswestry Dysfunction Index(ODI)and Visual Analog Scale(VAS)scores of the two groups of patients were lower than those before surgery,and the difference was statistically significant(P<0.05),but there was no statistically significant difference between the two groups(P>0.05);The postoperative complications in the percutaneous approach group were lower than those in the paravertebral muscular interspace approach group,but there was no statistically significant difference between the two groups(P>0.05).Conclusion Both approaches can effectively treat patients with traumatic lumbar fractures,improving their lower back pain and functional impairment.The percutaneous approach has the advantages of smaller surgical incisions and less intraoperative bleeding,while the paraspinal interspace approach can effectively shorten the patient's hospitalization time.Clinically,appropriate surgical methods can be selected based on the patient's condition.