经皮椎弓根螺钉内固定与切开复位内固定治疗无神经损伤单节段胸腰椎骨折的对比研究
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摘要
目的探讨经皮椎弓根螺钉内固定与常规切开复位内固定治疗无神经损伤单节段胸腰椎骨折的临床疗效。方法收集2014年4月至2016年4月北京市房山区良乡医院收治的单节段胸腰椎骨折患者64例,均无神经损伤症状,不合并其他脏器损伤。分为微创组及开放组,其中微创组36例,采用经皮椎弓根螺钉内固定治疗,开放组28例,采用常规切开复位内固定治疗。比较两组患者手术时间、出血量、下地时间、住院天数,术中复位后及术后6个月的Cobb角度及椎体高度矫正情况,术前、术后1周及术后6个月的疼痛视觉模拟评分(visual analogue score, VAS)情况。结果所有患者均未出现术后感染、内固定松动、内固定断裂等严重并发症。两组患者手术时间、出血量、下地时间、住院天数差异有统计学意义(P<0.05),矫正Cobb角度、矫正受伤椎体高度百分比在术中复位后、术后3个月差异均无统计学意义(P>0.05),术前及术后6个月VAS评分差异无统计学意义(P>0.05),术后1周VAS评分差异有统计学意义(P<0.05)。结论经皮椎弓根钉内固定术治疗胸腰椎骨折是一种安全、有效的微创治疗方法,能够明显减少手术时间、出血量,早期下地,恢复快,患者满意度高。
Objective To explore the clinical effects of percutaneous pedicle fixation and conventional pedicle screw fixation for the treatment of unstable single thoracolumbar vertebral fractures without nerve injury. Methods From April 2014 to April 2016, 64 patients with single-segment thoracolumbar fractures without nerve damage were admitted. The patients were divided into 2 groups. Percutaneous pedicle screw was implanted in experimental group(n=36)and conventional pedicle screw was implanted in control group(n=28). The perioperative data including duration of operation, blood loss volume,times of fluoroscopy examination, ambulation time, length of hospital stay were compared between 2 groups. Vertebral height and Cobb angle of 2 groups were compared intraoperatively and postoperatively. VAS before surgery, 1 week and 6 months after surgery were evaluated. Results No patients suffered from postoperative infection, internal fixation loosening or breakage or other complications. There were significant differences in duration of operation, blood loss volume, ambulation time and length of hospital stay between the two groups(P<0.05). Radiographic vertebral height and kyphosis Cobb angle were recovered obviously after surgery, but there were no significant differences(P>0.05). There were no significant differences between groups before surgery and 6 months after surgery in VAS(P>0.05). However,there were significant differences after 1 week in VAS(P<0.05). Conclusions Percutaneous pedicle fixation is a safe,effective,minimal invasive method for unstable single thoracolumbar vertebral fractures without nerve injury.
Objective To explore the clinical effects of percutaneous pedicle fixation and conventional pedicle screw fixation for the treatment of unstable single thoracolumbar vertebral fractures without nerve injury. Methods From April 2014 to April 2016, 64 patients with single-segment thoracolumbar fractures without nerve damage were admitted. The patients were divided into 2 groups. Percutaneous pedicle screw was implanted in experimental group(n=36)and conventional pedicle screw was implanted in control group(n=28). The perioperative data including duration of operation, blood loss volume,times of fluoroscopy examination, ambulation time, length of hospital stay were compared between 2 groups. Vertebral height and Cobb angle of 2 groups were compared intraoperatively and postoperatively. VAS before surgery, 1 week and 6 months after surgery were evaluated. Results No patients suffered from postoperative infection, internal fixation loosening or breakage or other complications. There were significant differences in duration of operation, blood loss volume, ambulation time and length of hospital stay between the two groups(P<0.05). Radiographic vertebral height and kyphosis Cobb angle were recovered obviously after surgery, but there were no significant differences(P>0.05). There were no significant differences between groups before surgery and 6 months after surgery in VAS(P>0.05). However,there were significant differences after 1 week in VAS(P<0.05). Conclusions Percutaneous pedicle fixation is a safe,effective,minimal invasive method for unstable single thoracolumbar vertebral fractures without nerve injury.
引文
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[6]Phan K,Rao PJ,Mobbs RJ.Percutaneous versus open pedicle screw fixation for treatment of thoracolumbar fractures:systematic review and meta-analysis of comparative studies[J].Clin Neurol Neurosurg,2015,135:85-92.
[7]Dong SH,Chen HN,Tian JW,et al.Effects of minimally invasive percutaneous and trans-spatium intermuscular short-segment pedicle instrumentation on thoracolumbar mono-segmental vertebral fractures without neurological compromise[J].Orthop Traumatol Surg Res,2013,99:405-411.
[8]Weiner BK,Walker M,Brower RS,et al.Microdecompression for lumbar spinal canal stenosis[J].Spine(Phila Pa 1976),1999,24:2268-2272.
[9]李强,尚雁峰,张志强.经皮椎弓根螺钉固定治疗胸腰段骨折的临床观察[J].北京医学,2017,39:673-677.
[10]Kim DY,Lee SH,Chung SK,et al.Comparison of multifidus muscle atrophy and trunk extension muscle strength:percutaneous versus open pedicle screw fixation[J].Spine(Phila Pa 1976),2005,30:123-129.
[11]Siebenga J,Leferink VJ,Segers MJ,et al.Treatment of traumatic thoracolumbar spine fractures:a multicenter prospective randomized study of operative versus nonsurgical treatment[J].Spine(Phila Pa1976),2006,31:2881-2890.
[12]Lee JK,Jang JW,Kim TW,et al.Percutaneous short-segment pedicle screw placement without fusion in the treatment of thoracolumbar burst fractures:is it effective?:comparative study with open short-segment pedicle screw fixation with posterolateral fusion[J].Acta Neurochir(Wien),2013,155:2305-2312.
[2]Korovessis P,Baikousis A,Zacharatos S,et al.Combined anterior plus posterior stabilization versus posterior short-segment instrumentation and fusion for mid-lumbar(L2-L4)burst fractures[J].Spine(Phila Pa 1976),2006,31:859-868.
[3]Tan BB,Chan CY,Saw LB,et al.Percutaneous pedicle screw for unstable spine fractures in polytraumatized patients:a report of two cases[J].Indian J Orthop,2012,46:710-713.
[4]陈宾,潘玉林,郭小伟,等.经皮微创与常规切开椎弓根螺钉内固定治疗不稳定性胸腰椎骨折的对比研究[J].中国骨与关节外科,2014,7:203-207.
[5]Assaker R.Minimal access spinal technologies:state-of-the-art,indications,and techniques[J].Joint Bone Spine,2004,71:459-469.
[6]Phan K,Rao PJ,Mobbs RJ.Percutaneous versus open pedicle screw fixation for treatment of thoracolumbar fractures:systematic review and meta-analysis of comparative studies[J].Clin Neurol Neurosurg,2015,135:85-92.
[7]Dong SH,Chen HN,Tian JW,et al.Effects of minimally invasive percutaneous and trans-spatium intermuscular short-segment pedicle instrumentation on thoracolumbar mono-segmental vertebral fractures without neurological compromise[J].Orthop Traumatol Surg Res,2013,99:405-411.
[8]Weiner BK,Walker M,Brower RS,et al.Microdecompression for lumbar spinal canal stenosis[J].Spine(Phila Pa 1976),1999,24:2268-2272.
[9]李强,尚雁峰,张志强.经皮椎弓根螺钉固定治疗胸腰段骨折的临床观察[J].北京医学,2017,39:673-677.
[10]Kim DY,Lee SH,Chung SK,et al.Comparison of multifidus muscle atrophy and trunk extension muscle strength:percutaneous versus open pedicle screw fixation[J].Spine(Phila Pa 1976),2005,30:123-129.
[11]Siebenga J,Leferink VJ,Segers MJ,et al.Treatment of traumatic thoracolumbar spine fractures:a multicenter prospective randomized study of operative versus nonsurgical treatment[J].Spine(Phila Pa1976),2006,31:2881-2890.
[12]Lee JK,Jang JW,Kim TW,et al.Percutaneous short-segment pedicle screw placement without fusion in the treatment of thoracolumbar burst fractures:is it effective?:comparative study with open short-segment pedicle screw fixation with posterolateral fusion[J].Acta Neurochir(Wien),2013,155:2305-2312.