摘要
目的 比较切开复位与微创经皮椎弓根螺钉内固定治疗胸腰椎骨折的疗效.方法 将80 例胸腰椎骨折患者根据手术方式不同分为切开组(采用切开复位椎弓根螺钉内固定治疗,40 例)与经皮组(采用微创经皮椎弓根螺钉内固定治疗,40 例).比较两组手术情况、疼痛VAS评分、伤椎前缘高度百分比、伤椎Cobb角以及并发症发生情况.结果 患者均获得随访,时间12～15 个月.切口长度、手术时间、术中出血量、术后下地时间、住院时间:经皮组均短(少)于切开组(P＜0.05).术中透视次数:两组比较差异无统计学意义(P＞0.05).疼痛VAS评分:术后1 d、1 周、1 个月经皮组均低于切开组(P＜0.05),术后12 个月两组比较差异无统计学意义(P＞0.05).伤椎前缘高度比、伤椎Cobb角:术后 1 周经皮组均优于切开组(P＜0.05),术后 12个月两组比较差异均无统计学意义(P＞0.05).术后并发症发生率:经皮组低于切开组(P＜0.05).结论 微创经皮椎弓根螺钉内固定治疗胸腰椎骨折切口小、创伤小、疼痛轻、患者康复快,临床疗效优于切开复位椎弓根螺钉内固定.
Abstract
Objective To compare the efficacy of open reduction and minimally invasive percutaneous pedicle screw fixation in the treatment of thoracolumbar fracture.Methods The 80 patients with thoracolumbar fractures were di-vided into open group(40 cases were treated with open reduction pedicle screw internal fixation)and percutaneous group(40 cases were adopted with minimally invasive percutaneous pedicle screw internal fixation),according to dif-ferent surgical methods.The surgical status,pain VAS,the anterior margin height ratio and Cobb angle of injured ver-tebra and complications were compared between the two groups.Results All patients were followed up for 12～15 months.Incision length,operation time,intraoperative blood loss,postoperative walking on ground time,hospitalization time:The data of percutaneous group were shorter(less)than those in open group(P＜0.05).There was no statistical difference in the intraoperative fluoroscopy frequency between two groups(P＞0.05).Pain VAS:At1 d,1 week,1 month after operation,percutaneous group was lower than open group(P＜0.05);at 12 months after surgery,there was no statistical difference between the two groups(P＞0.05).The ratio of anterior margin height and Cobb angle of injured vertebrae:At 1 week after surgery,the data of percutaneous group were better than those in open group(P＜0.05),and there were no statistical differences between the two groups at 12 months after surgery(P＞0.05).The in-cidence of postoperative complications in percutaneous group was lower than that in open group(P＜0.05).Conclu-sions In the treatment of thoracolumbar fracture,minimally invasive percutaneous pedicle screw internal fixation is superior to open reduction pedicle screw internal fixation,with small incision,less trauma,light pain,faster recovery,and better clinical effect.
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