不同手术入路对椎弓根内固定手术治疗胸腰椎骨折效果的影响

Effect of different surgical approaches on the treatment of thoracolumbar fracture with pedicle internal fixation

目的:探究不同手术入路椎弓根内固定手术治疗胸腰椎骨折的效果。方法:选取2021年9月~2023年9月期间本院收治的84例胸腰椎骨折患者作为研究对象。随机将患者分为对照组和观察组,每组各42例。两组均行椎弓根内固定手术。对照组经肌间隙入路行椎弓根内固定术。观察组经皮入路行椎弓根内固定术。观察对比两组的手术情况、并发症发生情况、疼痛程度[疼痛视觉模拟量表(Visual analogue scales,VAS)]、伤椎恢复情况[功能障碍Oswestry功能障碍指数(Oswestry disability Index,ODI)、伤椎前缘高度比、伤椎后凸Cobb角]、安全性指标[血清肌酸激酶(Creatine kinase,CK)、肌红蛋白(Myoglobin,MB)、乳酸脱氢酶(Lactate dehydro-genase,LDH)]。结果:观察组的手术时间、术中透视时长、首次下床、住院时间均比对照组显著缩短(P<0.05);观察组的术中出血量及术后24 h引流量均比对照组显著减少(P<0.05)。两组并发症发生率对比无显著差异(P>0.05)。两组术后1 d、出院前VAS评分均比术前呈下降趋势,且观察组术后1 d、出院前VAS评分均显著低于对照组(P<0.05)。两组出院前ODI指数、伤椎后凸Cobb角就均较术前下降,伤椎前缘高度较术前上升,但两组间对比无显著差异(P>0.05)。与术前相比,术后当天两组的CK、MB、LDH水平均显著升高,但组间比较无明显差异(P>0.05)。结论:经肌间隙入路与经皮入路椎弓根内固定手术在治疗胸腰椎骨折中都具有安全性、有效性,但经皮入路创口较小,更有利于术后恢复,且术后疼痛感更轻。

Objective:To explore the effect of different surgical approaches of pedicle internal fixation in the treatment of thoracolumbar fracture.Methods:84 patients with thoracolumbar fracture treated in our hospital from September 2021 to September 2023 were selected as the study objects.The patients were randomly divided into control group and observation group,with 42 cases in each group.Both groups underwent pedicle internal fixation.The control group underwent pedicle fixation via intermuscular approach.Observation group underwent pedicle fixation via percutaneous approach.The surgical status,complications,pain degree[Visual analogue scales(VAS)],recovery status of injured vertebra[Oswestry Disability Index(ODI),ratio of anterior vertebra height to injured vertebra kiphosis Cobb Angle],safety indexes[serum creatine kinase(CK),myoglobin(MB),and lactate dehydrogenation(LDH)]of the two groups were observed and compared.Results:The operation time,intraoperative fluoroscopy time,first time out of bed and hospital stay in the observation group were significantly shorter than those in the control group(P<0.05).The intraoperative blood loss and 24 hours postoperative drainage volume in the observation group were significantly reduced compared with the control group(P<0.05).There was no significant difference in complication rate between the two groups(P>0.05).VAS scores 1 day after surgery and before discharge in both groups showed a downward trend compared with those before surgery,and VAS scores 1 day after surgery and before discharge in the observation group were significantly lower than those in the control group(P<0.05).Before discharge,ODI index and Cobb Angle of injured vertebra kyphosis decreased,and the height of injured vertebra front increased,but there was no significant difference between the two groups(P>0.05).Compared with pre-operation,CK,MB and LDH levels in both groups were significantly increased on the day after surgery,but there was no significant difference between groups(P>0.05).Conclusion:Both the intermuscular approach and the percutaneous approach for pedicle internal fixation are safe and effective in the treatment of thoracolumbar fracture,but the percutaneous approach is more conducive to postoperative recovery with smaller wounds and less postoperative pain.