O型臂导航下经皮置钉与开放Wiltse入路置钉治疗无神经症状胸腰段骨折的疗效对比

O-arm-assisted percutaneous fixation versus open Wiltse approach foRthoracolumbaRfracture without neurological deficits

目的 评估O型臂导航辅助下经皮椎弓根螺钉内固定和开放Wiltse入路内固定治疗无神经功能障碍的胸腰椎骨折临床效果。方法 回顾性分析2019年1月-2021年1月河南省人民医院脊柱脊髓外科收治的70例无神经症状胸腰椎骨折患者的临床资料,按照置钉方法分为O型臂导航组和Wiltse入路组(各35例)。采用O型臂导航辅助下经皮椎弓根置钉为O型臂导航组,其中男性23例,女性12例;年龄27~65岁,平均45.7岁;高处坠落伤10例,道路交通伤18例,砸伤7例,患者共置入140枚螺钉。开放Wiltse入路椎弓根置钉为Wiltse入路组,其中男性19例,女性16例;年龄28~64岁,平均46.4岁;高处坠落伤9例,道路交通伤17例,砸伤9例,患者共置入150枚椎弓根螺钉。记录并比较两组手术时间、辐射剂量、置钉准确率,观察并发症,比较两组术前、术后1周及末次随访时VAS、Oswestry功能障碍指数(ODI),术前、术后2d及末次随访伤椎后凸Cobb角、伤椎前缘高度等指标。结果 O型臂导航组与Wiltse入路组患者手术时间、住院时间、切口总长度、置钉准确率比较,差异均无统计学意义[(73.2±10.0) min vs.(76.0±11.9)min、(4.7±0.7) d vs.(4.5±0.5) d、(7.5±0.5) cm vs.(7.7±0.9)cm、94.7%vs.97.1%,P>0.05]。O型臂导航组失血量及手术室辐射剂量均少于Wiltse入路组,差异有统计学意义[(47.2±8.4)mL vs.(73.1±24.6)mL、(353.7±90.9)cGy/cm2vs.(424.2±93.2)cGy/cm2,P<0.05]。术后1周时O型臂导航组VAS显著低于Wiltse入路组[(1.2±0.4)分vs.(2.9±0.4)分,P<0.05]。两组患者末次随访VAS、ODI、伤椎局部后凸Cobb角、伤椎椎体前缘高度与术前比较差异均有统计学意义(P<0.05),但两组间比较差异无统计学意义(P>0.05)。结论 经Wiltse肌间隙入路和O型臂导航辅助经皮椎弓根置钉治疗胸腰段脊柱骨折的效果相当,但O型臂导航辅助经皮固定可减少出血量和术中放射剂量,还可减轻术后早期疼痛。

Objective To compare the clinical outcomes of thoracolumbaRfractures without neurological deficits by percutaneous pedicle screw fixation assisted by O-arm navigation versus open Wiltse approach fixation.Methods Clinical data of 70 cases of thoracolumbaRfractures without neurological deficits in ouRdepartment from Jan.2019 to Jan.2021 were retrospectively analyzed.Based on the method of pedicle screw placement,patients were divided into two groups:O-arm navigation group(n=35,23 males and 12 females aged 27-65 years,mean 45.7 years,with 10 falls from height,18 road traffic injuries,and 7 crush injuries;altogetheR140 pedicle screws were installed)and open Wiltse approach group(n=35,19 males and 16 females aged 28-64 years,mean 46.4 years,with 9 falls from height,17 road traffic injuries and 9 crush injuries;altogetheR150 pedicle screws were installed).The operation time,radiation dose,pedicle screw placement accuracy and complications were collected.The visual analogue scale/score(VAS),Oswestry disability index(ODI),local Cobb angle and anterioRedge height of the injured vertebra before surgery,one week/2 days afteRsurgery,and at last follow-up were compared between two groups.Results The operation time(min,73.2±10.0 vs.76.0±11.9),length of hospital stay(d,4.7±0.7 vs.4.5±0.5),total incision length(cm,7.5±0.5 vs.7.7±0.9)and pedicle screw placement accuracy(94.7%vs.97.1%)showed comparable results between two groups(all P>0.05),but the O-arm navigation group revealed significantly less intraoperative blood loss(mL,47.2±8.4 vs.73.1±24.6)and radiation dose(cGy/cm 2,353.7±90.9 vs.424.2±93.2)than the Wiltse approach group(both P<0.05).The VAS score at 1 week afteRsurgery was also much loweRin the O-arm navigation group than in the Wiltse approach group(1.2±0.4 vs.2.9±0.4,P<0.05).At last follow-up,the VAS,ODI,local Cobb angle and anterioRedge height of the fractured vertebra were significantly improved than those before surgery(all P<0.05),but there was no significant difference between the two groups(all P>0.05).Conclusion O-arm navigation-assisted percutaneous pedicle screw placement and open Wiltse approach fixation are comparable in the treatment of thoracolumbaRspinal fractures,but the formeRcan reduce intraoperative blood loss and radiation,and alleviate pain postoperatively.