微创椎弓根钉内固定术治疗不稳定胸腰椎骨折的疗效观察

目的比较椎弓根钉内固定术治疗不稳定胸腰椎骨折的两种置钉方法的疗效。方法无神经损伤的不稳定胸腰椎骨折患者70例,分别采用微创椎弓根螺钉内固定(35例)及开放椎弓根螺钉内固定术(35例)进行治疗,评估两组患者手术切口长度、手术时间、失血量、影像学指标、腰背疼痛改善情况。结果 70例均获得6~14个月的随访,平均随访10个月。两组在手术时间方面差异无统计学意义(P0.05),在手术切口长度、失血量方面差异有统计学意义(P0.05);两组术后矢状位后凸Cobb角、伤椎椎体前缘高度较术前均有明显改善(P0.05),术后两组在Cobb角、伤椎前缘高度的改善程度比较差异无统计学意义(P0.05);术后早期两组VAS评分比较差异有统计学意义(P0.05),但术后半年时两组VAS评分比较差异无统计学意义(P0.05)。结论微创椎弓根螺钉固定术是治疗无神经损伤不稳定胸腰椎骨折的有效方法,具有创伤小、恢复快的优点,临床值得推广应用。

Observation on the therapeutic effect of microinvasive pedicle screw fixation in the treatment of unstable thoracolumbar fracture

Objective To compare the therapeutic effect between two pedicle screw fixation methods with different screw placing ways in treating unstable thoracolumbar fracture. Methods 70 thoracolumbar fracture patients without neurological symptoms were enrolled in the research. 35 patients were treated with minimally invasive percutaneous pedicle screw fixation and 35 cases with the traditional open pedicle screw fixation. Operation time,operative incision length and bleeding volume,radiographic index,and relief of the low back pain were documented and compared between the two groups. Results All patients have been followed up for 6 to14 months,10 months on the average. The consumed time of operation made no significant difference（ P 〉0. 05）. There were significant differences in the length of size, surgical blood loss,（ P〈0. 05）. The Cobb angle,anterior height of the fracture vertebral body were all significantly improved after operation in each group（ P〈0. 05）. There was no significant difference in postoperative improvement of Cobb angle,or anterior height of the fracture vertebral body between the two groups（ P〉0. 05）. The improvement in VAS of back pain was of significant difference between the two groups until 6 months after the operation. Conclusions Minimally invasive percutaneous pedicle screw fixation is an effective method to treat thoracolumbar fracture,for it has the advantages of small trauma,less bleeding,light pain,and quick recovery.