经椎旁肌间隙入路与经皮入路椎弓根螺钉内固定治疗无神经症状胸腰椎骨折的疗效比较

Comparison of Therapeutic Effectiveness of Paraspinal Muscle Gap Approach vs.Percutaneous Approach Pedicle Screw Fixation for Thoracolumbar Fractures without Neurological Symptoms

目的比较经椎旁肌间隙入路与经皮入路椎弓根螺钉内固定术治疗无神经症状胸腰椎骨折的临床疗效。方法收集2017年2月至2018年10月期间苏州大学附属第一医院收治的59例无神经症状的单节段胸腰椎骨折病人的临床资料,进行回顾性分析,其中男51例,女8例,平均年龄为46.8岁(19~67岁)。均采用椎弓根螺钉内固定手术,24例采用经椎旁肌间隙入路的病人纳入经肌间隙入路组,35例采用经皮入路的病人纳入经皮入路组。比较两组病人的手术相关指标(术中出血量、手术时间、切口总长度、住院总时间、术后下床时间),术前、术后1周及术后6个月的疼痛视觉模拟量表(VAS)评分,术前及术后椎体前缘高度百分比、Cobb角以及螺钉置入精确度。结果病人获得(16.1±4.2)月(12~28个月)随访。经肌间隙入路组的手术时间显著少于经皮入路组[(114.00±48.56)min vs.(153.29±52.46)min],住院总时间显著多于经皮入路组[(12.92±4.97)d vs.(10.40±4.14)d],差异有统计学意义(P<0.05)。两组术后的VAS评分均较术前显著降低,椎体前缘高度百分比均较术前明显增加,术后Cobb角均较术前明显减小,但两组间比较,差异均无统计学意义(P>0.05)。术后经肌间隙入路组的螺钉置入精确度:Ⅰ级128钉,Ⅱ级13钉,Ⅲ级3钉;经皮入路组为:Ⅰ级177钉,Ⅱ级22钉,Ⅲ级1钉,组间差异无统计学意义(P>0.05)。结论经椎旁肌间隙入路与经皮入路椎弓根螺钉内固定术治疗无神经症状的胸腰椎骨折均具有较好的临床疗效,前者在手术时间更有优势,后者在住院总时间更有优势。

Objective To compare the clinical efficacy of paraspinal muscle gap approach vs.percutaneous approach pedicle screw fixation in the treatment of thoracolumbar fractures without neurological symptoms.Methods A retrospective case⁃control study was used to analyze the clinical data of 59 patients with single⁃segment thoracolumbar fractures without neurological symptoms admitted to the First Affiliated Hospital of Suzhou University from February 2017 to October 2018.There were 51 males and 8 females,aged from 19 to 67 years(mean 46.8 years).Totally,24 cases received paraspinal muscle gap approach pedicle screw fixation(muscle gap approach group)and 35 cases received percutaneous approach pedicle screw fixation(percutaneous approach group).The operation time,intraoperative blood loss,total incision length,time to get out of bed after operation,total hospitalization time between two groups of surgical patients were compared.The visual analogue scale(VAS)scores before operation,1 week and 6 months after operation,the height percentage of vertebral body’s anterior edge and the Cobb angle preoperation and postoperation,accuracy of pedicle screw placement were compared between the two groups.Results All patients were followed up for 12 to 28 months[(16.1±4.2)months].The operation time in the muscle gap approach group was significantly shorter than that in the percutaneous approach group[(114.00±48.56)min vs.(153.29±52.46)min],the total hospitalization time in the muscle gap approach group was significantly longer than that in the percutaneous approach group[(12.92±4.97)d vs.(10.40±4.14)d],with the difference being statistically significant(P<0.05).In both groups after operation,the VAS scores were significantly lower,the postoperative height percentage of vertebral body’s anterior edge was significantly higher,and the postoperative Cobb angle was significantly lower than those preoperation,but there was no statistically significant difference between the two groups(P>0.05).The accuracy of pedicle screw placement in the muscle gap approach group was 128 screws in gradeⅠ,13 screws in gradeⅡ,and 3 screws in gradeⅢ,and 177 screws in gradeⅠ,22 screws in gradeⅡ,and 1 screw in gradeⅢin the percutaneous approach group.The difference was not statistically significant(P>0.05).Conclusion Both paraspinal muscle gap approach and percutaneous approach pedicle screw fixation have good clinical effects in the treatment of thoracolumbar fractures without neurological symptoms.The former has more advantages in operation time,while the latter has more advantages in total hospitalization time.