[1]吴溢峰 谭洁詠 吴焯鹏 钟姣红**.经皮与开放椎弓根钉内固定治疗胸腰椎骨折的疗效比较[J].中国微创外科杂志,2020,01(11):982-986.
　Wu Yifeng,Tan Jieyong,Wu Zhuopeng,et al.Comparison of Percutaneous and Open Pedicle Screw Fixation in the Treatment of Thoracolumbar Fractures[J].Chinese Journal of Minimally Invasive Surgery,2020,01(11):982-986.
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经皮与开放椎弓根钉内固定治疗胸腰椎骨折的疗效比较()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2020年11期
页码:
982-986
栏目:
临床研究
出版日期:
2020-11-25

文章信息/Info

Title:
Comparison of Percutaneous and Open Pedicle Screw Fixation in the Treatment of Thoracolumbar Fractures
作者:
吴溢峰 谭洁詠 吴焯鹏 钟姣红**
（广东省开平市中心医院骨科，开平529300）
Author(s):
Wu Yifeng;  Tan Jieyong;  Wu Zhuopeng;  et al.
Department of Orthopaedics, Central Hospital of Kaiping, Kaiping 529300, China
关键词:
经皮椎弓根钉; 胸腰椎骨折; 内固定
Keywords:
Percutaneous pedicle screw; Thoracolumbar fracture; Internal fixation
文献标志码:
A
摘要:
目的比较经皮与开放椎弓根钉内固定治疗胸腰椎骨折的临床效果。方法我院2017年2月~2019年6月54例单节段无神经损伤的胸腰椎骨折，根据手术方式分成2组：经皮组23例，开放组31例。比较2组手术时间、切口长度、术中出血量、住院时间、伤椎前缘高度、后凸Cobb角、疼痛视觉模拟评分（Visual Analogue Scale,VAS)、Oswestry功能障碍指数（Oswestry Disability Index,ODI)及并发症情况。结果54例均顺利完成手术，经皮组手术时间明显短于开放组［(80.7±10.6) min vs.(106.2±13.7) min，t=-7.401，P=0.000］，手术切口长度明显小于开放组［(6.7±1.0) cm vs. (8.8±1.5)cm，t=-6.079，P=0.000］，出血量明显少于开放组［(56.3±13.5) ml vs.(197.2±32.0) ml，t=-22.004，P=0.000］，住院时间明显短于开放组［(10.4±1.7) d vs.(13.6± 2.8) d，t=-5.221，P=0.000］。经皮组23例切口均一期愈合，未发生并发症；开放组2例切口浅表感染，1例局部皮缘坏死，均延期愈合。2组并发症发生率无统计学差异（Fisher精确检验，P=0253）。54例随访12~19个月，（15.5±2.3）月。术后1周2组VAS评分、ODI均较术前明显降低(P<0.05)，经皮组VAS 评分中位数明显低于开放组［2.0（2~3）分 vs. 4.0（3~5）分，Z=-6.023，P=0.000］，ODI明显低于开放组［(16.1±1.6)% vs. (18.3±1.7)%，F=22.314，P=0.000］；术后3、12个月2组VAS评分、ODI均进一步降低（P均=0.000）。2组术后伤椎前缘高度（F=112.018，P=0.000）、后凸Cobb角（F=202.007，P=0.000）均较术前明显恢复，组间比较差异无显著性（椎体前缘高度：F=0.000，P=0.985；Cobb角：F=0.678,P=0.414）。结论2种方法均能治疗胸腰椎骨折，恢复椎体高度，纠正后凸畸形，缓解症状，但经皮椎弓根钉内固定手术时间更短，切口更小，出血量更少，术后恢复更快。
Abstract:
ObjectiveTo compare the clinical efficacy of percutaneous and open pedicle screw fixation in the treatment of thoracolumbar fractures.MethodsA retrospective analysis was performed on 54 patients with singlesegment thoracolumbar fractures without neurological deficits in our hospital from February 2017 to June 2019, who were divided into two groups based on the operation methods: 23 in the percutaneous group and the remaining 31 in the open group. The operation time, incision length, blood loss, hospital stay, anterior height of fractured vertebrae, Cobb angle, Visual Analogue Scale(VAS) scores, Oswestry Disability Index(ODI) and complications were compared between the two groups.ResultsAll the 54 patients had a smooth operation procedure. The operation time of the percutaneous group was less than that of the open group ［(80.7±10.6) min vs. (106.2±13.7) min, t=-7.401, P=0.000］. The percutaneous group had a shorter incision length ［(6.7±1.0) cm vs. (8.8±1.5) cm, t=-6.079, P=0.000］, less blood loss ［(56.3±13.5) ml vs. (197.2±32.0) ml, t=-22.004, P=0.000］ and shorter hospital stay ［(104±1.7) d vs.(13.6± 2.8) d, t=-5.221, P=0.000］ than its counterpart. All the incisions in the percutaneous group healed without complications, while in the open group there were 2 cases of superficial infection and 1 case of local skin necrosis, both of which achieved delayed incision healing. However, there was no statistically significant difference in the incidence of complications between the two groups (Fisher’s exact test,P=0.253).All the 54 cases were followed up for 12-19 months ［mean,(15.5±2.3) months］.Both VAS scores and ODI in the two groups 1 week after operation significantly decreased compared with those before operation(P<0.05).There were less VAS ［2.0 (2-3) points vs. 4.0 (3-5) points, Z=-6.023, P=0.000］ and ODI ［(16.1 ±1.6)% vs. (18.3±1.7)%, F=22.314, P=0000］ in the percutaneous group than those in the open group 1 week after operation, which both became further reduced at three or twelve months postoperatively (VAS: Z=-4.275, P=0.000; ODI: F=7515.041, P=0.000). The anterior vertebral height (F=112.018, P=0.000) and Cobb angle (F=202.007, P=0.000) of the injured vertebra were restored compared with those before operation, although no significant differences between groups (vertebral height: F=0.000, P=0.985; Cobb angle: F=0.678, P=0.414). ConclusionsBoth percutaneous and open pedicle screw fixation can treat thoracolumbar fracture by restoring vertebral body height, correcting kyphosis, and relieving symptoms. However, percutaneous pedicle screw fixation is superior due to shorter operation time, smaller incision, less blood loss and faster postoperative recovery.

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备注/Memo

备注/Memo:
基金项目：江门市科技局科研项目（2020YLJ005）**通讯作者，Email：409069242@qq.com
更新日期/Last Update: 2021-02-07