经皮微创与开放式椎弓根螺钉内固定治疗胸腰椎骨折疗效对比
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摘要
目的 :比较经皮微创椎弓根螺钉内固定术与开放式椎弓根内固定术治疗胸腰椎骨折的临床疗效。方法 :将2012年4月～2017年4月于本院进行治疗的150例胸腰椎骨折的患者作为研究对象,依据手术方式分为微创组和开放组,开放组采用开放式椎弓根螺钉内固定术,微创组采用经皮微创螺钉内固定术。将两组患者的手术时间、术中出血量、固定强度、骨折复位情况、治疗前后椎体前缘高度比、后凸Cobb角、并发症发生率、术后满意度、晚期矫正度丢失、住院时间、术后卧床时间、术后疼痛视觉模拟评分(visual analogue scale,VAS)等指标进行比较。结果 :微创组的术中出血量、住院时间少于开放组;微创组并发症发生率低于开放组;手术时间、固定强度、晚期矫正度丢失两组相比,差异无统计学意义;术后满意度两组相比,微创组高于开放组,但差异无统计学意义;微创组骨折复位情况与开放组相比,差异不显著;微创组采用的手术操作技术难度大于开放组。微创组C反应蛋白水平术后24 h和48 h均低于开放组。术后24 h和术后21 d微创组VAS评分与开放组相比,差异不显著;术后48 h、7 d、14d微创组VAS评分显著低于开放组。治疗后椎体前缘高度比值和后凸Cobb角较治疗前均显著缩小,但术后两组比较差异均不显著。术后满意度两组相比差异不显著。结论 :经皮微创椎弓根螺钉内固定与开放式螺钉内固定疗效相当,但前者术中出血少、住院时间短等优点,但是存在手术操作技术难度大的缺点。
Objective To compare the clinical efficacy of open pedicle screw fixation and minimally invasive percutaneous for thoracolumbar spine fractures. Methods 140 cases were included from Apr.2012 to Apr.2017 in our hospital, 87 cases were treated by minimally invasive percutaneous pedicle screw fixation(minimally invasive group), and 63 cases were treated by traditional open pedicle screw fixation(open group). The differences of operation time, blood loss, fixation strength, fracture reduction, postoperative complications, postoperative satisfaction, the preoperative and postoperative visual analogue scale(VAS), the preoperation and postoperative anterior vertebral body height and cobb angle of the kyphosis were compared between the groups. Results Compared with the open group, the blood loss was less, hospital stay and bedridden time were shorter in the minimally invasive group. The operation time, fixation strength, loss of correction were similar between the two groups. The C-reactive protein in minimally invasive group was less than the open group at 24 hours and 48 hours. The VAS was less in the minimally invasive group at 48 hours, 72 hours and 14 days after the operation, but there was no different between two groups at 24 hours and 21 days after the operation. Postoperatively, the anterior vertebral body height was shorter and the Cobb angle of the kyphosis was corrected obviously in both groups, but no significant difference was found between two groups. The rate of postoperative complications was lower in the minimally invasive group. There was no obvious significance in the postoperative satisfaction between the two groups. Conclusion The two methods have the similar fixation efficacy in treating thoracolumbar fracture. However, the minimally invasive percutaneous pedicle screw fixation can reduce the blood loss, bedridden time and hospital stay, postoperative pain, but there are some disadvantages of surgical techniques.
Objective To compare the clinical efficacy of open pedicle screw fixation and minimally invasive percutaneous for thoracolumbar spine fractures. Methods 140 cases were included from Apr.2012 to Apr.2017 in our hospital, 87 cases were treated by minimally invasive percutaneous pedicle screw fixation(minimally invasive group), and 63 cases were treated by traditional open pedicle screw fixation(open group). The differences of operation time, blood loss, fixation strength, fracture reduction, postoperative complications, postoperative satisfaction, the preoperative and postoperative visual analogue scale(VAS), the preoperation and postoperative anterior vertebral body height and cobb angle of the kyphosis were compared between the groups. Results Compared with the open group, the blood loss was less, hospital stay and bedridden time were shorter in the minimally invasive group. The operation time, fixation strength, loss of correction were similar between the two groups. The C-reactive protein in minimally invasive group was less than the open group at 24 hours and 48 hours. The VAS was less in the minimally invasive group at 48 hours, 72 hours and 14 days after the operation, but there was no different between two groups at 24 hours and 21 days after the operation. Postoperatively, the anterior vertebral body height was shorter and the Cobb angle of the kyphosis was corrected obviously in both groups, but no significant difference was found between two groups. The rate of postoperative complications was lower in the minimally invasive group. There was no obvious significance in the postoperative satisfaction between the two groups. Conclusion The two methods have the similar fixation efficacy in treating thoracolumbar fracture. However, the minimally invasive percutaneous pedicle screw fixation can reduce the blood loss, bedridden time and hospital stay, postoperative pain, but there are some disadvantages of surgical techniques.
引文
[1]S Rajasekaran, Rishi Mugesh Kanna, Ajoy Prasad Shetty, et al. Management of thoracolumbar spine trauma:An overview[J]. Indian J Orthop.2015, 49(1):72-82.
[2]Fernando Ruiz Santiago, Pablo Tomás Mu?oz, Elena Moya Sánchez,et al. Classifying thoracolumbar fractures:role of quantitative imaging[J].Quant Imaging Med Surg.2016, 6(6):772-784.
[3]Tarek Ahmed Aly. Short Segment versus Long Segment Pedicle Screws Fixation in Management of ThoracolumbarBurst Fractures:Meta-Analysis[J]. Asian Spine J.2017, 11(1):150-160.
[4]Sharvil H Gajjar, Hari J Menon, Nitin Chaudhari, et al. Outcomes of Short Segment Posterior Instrumentation in Unstable Thoracolumbar Fractures[J]. J Clin Diagn Res.2016, 10(11):RC04-RC08.
[5]Sebastian Krinner, Sina Grupp, Pascal Oppel, et al. Do low profile implants provide reliable stability in fixing the sternal fractures as a “fourth vertebral column” in sternovertebral injuries[J]. J Thorac Dis.2017,9(4):1054-1064.
[6]R. M. Mitchell, P. Jewell, M. K, et al. Reporting of vertebral fragility fractures:can radiologists help reduce the number of hip fractures[J].Arch Osteoporos.2017, 12(1):71.
[7]Mehmet Onur Yüksel, Mehmet Sabri Gürbüz,?evki G?k, et al. The Association between Sagittal Index, Canal Compromise, Loss of Vertebral Body Height, and Severity of Spinal Cord Injury in Thoracolumbar Burst Fractures[J]. J Neurosci Rural Pract.2016, 7(Suppl 1):S57–S61.
[8]Varun Puvanesarajah, Jourdan M, Cancienne, et al. Complications after Fusion for Thoracolumbar Fractures in Patients with Ankylosing Spondylitis[J]. Global Spine J.2017, 7(1):28-32.
[9]Richard A. Lindtner, Christian Kammerlander, Michael Goetzen, et al.Fracture reduction by postoperative mobilisation for the treatment of hyperextension injuries of thethoracolumbar spine in patients with ankylosing spinal disorders[J]. Arch Orthop Trauma Surg.2017, 137(4):531-541.
[10] Moon Y J, Lee K B. Relationship between clinical outcomes and spontaneous canal remodeling in thoracolumbar Burst fracture[J]. World Neurosurg, 2016, 89(3):58-64.
[11] Heintel T M, Dannigkeit S, Fenwick A, et al. How safe is minimally invasive pedicle screw placement for treatment of thoracolumbar spine fractures?[J]. Eur Spine J, 2017, 26(5):1515-1524.
[12] Han G, He C, Shao L. Analysis on curative effect of percutaneous minimally invasive spinal internal fixation with pedicle screw rod system for thoracolumbar fracture[J]. Biomedical Research, 2017, 28(15):6848-6851.
[13] ZOU Wei, XIAO Jie, LONG Hao, et al. Screw placement selection of minimally invasive percutaneous pedicle screw fixation for thoracolumbar fractures[J].Chinese Journal of Tissue Engineering Research, 2017, 21(3):356-361.
[14] Li L, Dong Y, He Y, et al. Treatment of Thoracolumbar Fractures by Percutaneous Pedicle Screw Fixation Technique Combined with Threestep Reduction[J]. Journal of Neurological Surgery Part A:Central European Neurosurgery, 2017, 78(03):231-237.
[15] Eva Jacobs, Alex K. Roth, Jacobus J, et al. Reduction of intradiscal pressure by the use of polycarbonate-urethane rods as compared to titanium rods in posterior thoracolumbar spinal fixation[J]. J Mater Sci Mater Med.2017; 28(10):148.
[2]Fernando Ruiz Santiago, Pablo Tomás Mu?oz, Elena Moya Sánchez,et al. Classifying thoracolumbar fractures:role of quantitative imaging[J].Quant Imaging Med Surg.2016, 6(6):772-784.
[3]Tarek Ahmed Aly. Short Segment versus Long Segment Pedicle Screws Fixation in Management of ThoracolumbarBurst Fractures:Meta-Analysis[J]. Asian Spine J.2017, 11(1):150-160.
[4]Sharvil H Gajjar, Hari J Menon, Nitin Chaudhari, et al. Outcomes of Short Segment Posterior Instrumentation in Unstable Thoracolumbar Fractures[J]. J Clin Diagn Res.2016, 10(11):RC04-RC08.
[5]Sebastian Krinner, Sina Grupp, Pascal Oppel, et al. Do low profile implants provide reliable stability in fixing the sternal fractures as a “fourth vertebral column” in sternovertebral injuries[J]. J Thorac Dis.2017,9(4):1054-1064.
[6]R. M. Mitchell, P. Jewell, M. K, et al. Reporting of vertebral fragility fractures:can radiologists help reduce the number of hip fractures[J].Arch Osteoporos.2017, 12(1):71.
[7]Mehmet Onur Yüksel, Mehmet Sabri Gürbüz,?evki G?k, et al. The Association between Sagittal Index, Canal Compromise, Loss of Vertebral Body Height, and Severity of Spinal Cord Injury in Thoracolumbar Burst Fractures[J]. J Neurosci Rural Pract.2016, 7(Suppl 1):S57–S61.
[8]Varun Puvanesarajah, Jourdan M, Cancienne, et al. Complications after Fusion for Thoracolumbar Fractures in Patients with Ankylosing Spondylitis[J]. Global Spine J.2017, 7(1):28-32.
[9]Richard A. Lindtner, Christian Kammerlander, Michael Goetzen, et al.Fracture reduction by postoperative mobilisation for the treatment of hyperextension injuries of thethoracolumbar spine in patients with ankylosing spinal disorders[J]. Arch Orthop Trauma Surg.2017, 137(4):531-541.
[10] Moon Y J, Lee K B. Relationship between clinical outcomes and spontaneous canal remodeling in thoracolumbar Burst fracture[J]. World Neurosurg, 2016, 89(3):58-64.
[11] Heintel T M, Dannigkeit S, Fenwick A, et al. How safe is minimally invasive pedicle screw placement for treatment of thoracolumbar spine fractures?[J]. Eur Spine J, 2017, 26(5):1515-1524.
[12] Han G, He C, Shao L. Analysis on curative effect of percutaneous minimally invasive spinal internal fixation with pedicle screw rod system for thoracolumbar fracture[J]. Biomedical Research, 2017, 28(15):6848-6851.
[13] ZOU Wei, XIAO Jie, LONG Hao, et al. Screw placement selection of minimally invasive percutaneous pedicle screw fixation for thoracolumbar fractures[J].Chinese Journal of Tissue Engineering Research, 2017, 21(3):356-361.
[14] Li L, Dong Y, He Y, et al. Treatment of Thoracolumbar Fractures by Percutaneous Pedicle Screw Fixation Technique Combined with Threestep Reduction[J]. Journal of Neurological Surgery Part A:Central European Neurosurgery, 2017, 78(03):231-237.
[15] Eva Jacobs, Alex K. Roth, Jacobus J, et al. Reduction of intradiscal pressure by the use of polycarbonate-urethane rods as compared to titanium rods in posterior thoracolumbar spinal fixation[J]. J Mater Sci Mater Med.2017; 28(10):148.