经皮微创椎弓根螺钉内固定与开放手术治疗胸腰椎骨折临床疗效比较

目的:比较微创经皮椎弓根螺钉内固定与开放椎弓根螺钉内固定治疗胸腰椎骨折的疗效。方法 :回顾性分析2014年6月至2014年12月收治的61例需手术治疗的胸腰椎单纯骨折患者,其中29例采用经皮微创椎弓根钉棒系统治疗(微创组),32例采用传统切开暴露椎板椎弓根置钉内固定术治疗(开放组)。分别比较两组患者手术切口总长度、术中透视次数、手术时间、术中出血量、术前及术后疼痛视觉模拟评分、术后卧床及住院时间,并通过影像学检查比较治疗前后椎体前缘高度及后凸Cobb角变化。结果:与开放组相比,微创组手术切口总长度小、手术时间短、术中出血少、术后伤口疼痛缓解快、术后卧床及住院时间短。两组患者治疗后椎体前缘高度恢复明显,后凸Cobb角明显减小,但组间比较,差异均无统计学意义(P0.05)。结论:经皮微创椎弓根螺钉与开放手术具有相同的内固定效果,但可减小手术切口,避免开放手术广泛剥离腰背肌,缩短术后疼痛、卧床及住院时间,值得临床推广使用。

Comparative study of minimally invasive percutaneous pedicle screw fixation and open surgery in the treatment of thoracolumbar fractures

Objective: To compare the clinical outcomes of minimally invasive percutaneous pedicle screw fixation and open surgery in the treatment of thoracolumbar fracture.Methods: A retrospective study of patients who had undergone surgery for thoracolumbar fracture from June 2014 to December 2014 was performed. Sixty-one cases were included and 29 cases were treated by minimally invasive percutaneous pedicle screw fixation (minimally invasive group) and 32 cases were treated by the traditional open pedicle screw fixation(open group). The differences in the total length of the incision,intraoperative fluoroscopy times,operative time,blood loss,the preoperative and postoperative visual analogue scale(VAS),postoperative bedridden time and hospital stay were compared. And the preoperative and postoperative anterior vertebral body height and Cobb angle of the kyphosis were also compared.Results: Compared with the open group,the total length of incision was smaller and intraoperative blood loss was less,bedridden time and hospital stay were shorter,and pain of the wound was less in the minimally invasive group. Postoperatively,the anterior vertebral body height was retorted and the Cobb angle of the kyphosis was corrected obviously in both groups. But no significant difference in the imaging results was found between two groups(P>0.05).Conclusion: Minimally invasive percutaneous pedicle screw fixation has the similar fixation efficacy with open surgery in treating thoracolumbar fracture. However,it can avoid extensive muscle stripping,and obviously reduce the surgical incision,operative time,postoperative pain,bedridden time and hospital stay. According to the clinical efficacy,it is worthy of clinical application.