经皮微创椎弓根钉内固定术治疗无神经损伤症状的不稳定胸腰椎骨折

Clinical efficacy of percutaneous minimally invasive pedicle screw fixation for unstable thoracolumbar fracture without nerve injury

目的探讨经皮微创椎弓根钉内固定术治疗无神经损伤症状的不稳定胸腰椎骨折的疗效。方法回顾性分析我院2017年1月-2018年1月收治的不稳定胸腰椎骨折无神经损伤的患者86例,随机分成对照组与观察组,每组43例。对照组患者接受传统手术治疗,观察组患者接受经皮微创椎弓根钉内固定术治疗。在术前、术后1个月、6个月比较两组患者伤椎Cobb角、伤椎前缘高、视觉模拟评分(VAS)、Oswestry评分及术中出血量、手术时间。结果术前两组无神经损伤症状的不稳定胸腰椎骨折患者的患者伤椎Cobb角、伤椎前缘高度比较无差异(P>0.05)。术后1个月、6个月年观察组患者伤椎Cobb角、伤椎前缘高度低于对照组(P<0.05)。观察组不稳定胸腰椎骨折患者手术时间多于对照组(P<0.05),术中出血量少于对照组(P<0.05)。术前两组不稳定胸腰椎骨折患者VAS评分比较差异无统计学意义(P>0.05)。术后1上个月、6个月观察组患者VAS评分低于对照组(P<0.05)。术前两组不稳定胸腰椎骨折患者Oswestry评分比较无差异(P>0.05)。术后1个月、6个月观察组患者Oswestry评分低于对照组(P<0.05)。结论经皮微创椎弓根钉内固定术是治疗无神经损伤症状的不稳定胸腰椎骨折有效方法。该术式能显著减少术中出血量,改善腰椎功能,减少疼痛,值得推荐使用。

Objective To evaluate the efficacy of Percutaneous minimally invasive pedicle screw fixation in the treatment of unstable thoracolumbar fractures without neurological symptoms.Methods Eighty-six patients with unstable thoracolumbar fractures without neurological injury from January 2017 to January 1818 in our hospital were randomly divided into control group and observation group,with 43 cases in each group.Patients in the control group underwent conventional surgery,and patients in the observation group underwent percutaneous minimally invasive pedicle screw fixation.The Cobb angle of the injured vertebrae,the high margin of the injured vertebrae,the visual analogue scale(VAS),the Oswestry score,the intraoperative blood loss,and the operation time were compared before and 1 month and 6 months after operation.Results There was no difference in the height of Cobb angle and the leading edge of the injured vertebrae between the two groups of patients with unstable thoracolumbar fracture without neurological injury before operation(P>0.05).The height of Cobb angle and the leading edge of the injured vertebrae in the observation group at 1 month and 6 months after operation were significantly lower than those in the control group(P<0.05).The operation time of the unstable thoracolumbar fractures in the observation group was higher than that in the control group(P<0.05),and the intraoperative blood loss was less than that in the control group(P<0.05).There was no significant difference in VAS scores between the two groups of unstable thoracolumbar fractures before operation(P>0.05).The VAS scores of the observation group at 1 month and 6 months after operation were significantly lower than those of the control group(P<0.05).There was no difference in Oswestry score between the two groups of unstable thoracolumbar fractures before operation(P>0.05).The Oswestry score of the observation group was significantly lower than that of the control group at 1 month and 6 months after operation(P<0.05).Conclusion Percutaneous minimally invasive pedicle screw fixation is an effective method for the treatment of unstable thoracolumbar fracture without neurological injury.This procedure can significantly reduce the amount of intraoperative blood loss,improve lumbar function,reduce pain,and is recommended.