Comparison of Therapeutic Effectiveness of Paraspinal Muscle Gap Approach vs. Percutaneous Approach Pedicle Screw Fixation for Thoracolumbar Fractures without Neurological Symptoms
Objective To compare the clinical efficacy of paraspinal muscle gap approach vs.percutaneous approach pedicle screw fixation in the treatment of thoracolumbar fractures without neurological symptoms.Methods A retrospective case-control study was used to analyze the clinical data of 59 patients with single-segment thoracolumbar fractures without neurological symptoms admitted to the First Affiliated Hospital of Suzhou University from February 2017 to October 2018.There were 51 males and 8 females,aged from 19 to 67 years(mean 46.8 years).Totally,24 cases received paraspinal muscle gap approach pedicle screw fixation(muscle gap approach group)and 35 cases received percutaneous approach pedicle screw fixation(percutaneous approach group).The operation time,intraoperative blood loss,total incision length,time to get out of bed after operation,total hospitalization time between two groups of surgical patients were compared.The visual analogue scale(VAS)scores before operation,1 week and 6 months after operation,the height percentage of vertebral body's anterior edge and the Cobb angle preoperation and postoperation,accuracy of pedicle screw placement were compared between the two groups.Results All patients were followed up for 12 to 28 months[(16.1±4.2)months].The operation time in the muscle gap approach group was significantly shorter than that in the percutaneous approach group[(114.00±48.56)min vs.(153.29±52.46)min],the total hospitalization time in the muscle gap approach group was significantly longer than that in the percutaneous approach group[(12.92±4.97)d vs.(10.40±4.14)d],with the difference being statistically significant(P＜0.05).In both groups after operation,the VAS scores were significantly lower,the postoperative height percentage of vertebral body's anterior edge was significantly higher,and the postoperative Cobb angle was significantly lower than those preoperation,but there was no statistically significant difference between the two groups(P＞0.05).The accuracy of pedicle screw placement in the muscle gap approach group was 128 screws in gradeⅠ,13 screws in gradeⅡ,and 3 screws in gradeⅢ,and 177 screws in gradeⅠ,22 screws in gradeⅡ,and 1 screw in gradeⅢin the percutaneous approach group.The difference was not statistically significant(P＞0.05).Conclusion Both paraspinal muscle gap approach and percutaneous approach pedicle screw fixation have good clinical effects in the treatment of thoracolumbar fractures without neurological symptoms.The former has more advantages in operation time,while the latter has more advantages in total hospitalization time.
Thoracolumbar fracturesPedicle screw fixationMini-invasive therapyParaspinal muscle gap approachPercutaneous approach
万方数据
维普
