经皮与开放手术治疗胸腰椎骨折的比较研究

目的] 对比研究经皮微创手术和传统开放手术的临床疗效.方法] 自2006年4月～2008年12月治疗49例新鲜胸腰椎骨折患者,其中21例行经皮微创手术,28例行传统开放手术,比较围手术期参数、影像学指标、视觉模拟评分法(VAS),并在半年期随访时行椎旁肌肌电图评估.结果] 所有患者均获得了完整的随访,随访时间为6～31个月,平均13个月.两组相比较手术时间无明显差异,但术中出血量、住院天数、术后疼痛(VAS评分) 经皮微创组明显低于开放手术组;两组术前、术后影像学指标如椎体前缘高度、后凸Cobb's角、椎管堵塞指数对比有显著性差异,但两组术后影像学指标对比无明显差异;术后肌酸激酶水平明显低于开放手术组;开放手术组术后发现失神经电位,而经皮微创组未发现.结论] 经皮椎弓根微创手术治疗胸腰椎骨折具有创伤小,出血少,对椎旁肌损伤小,恢复快,疼痛轻等优点,值得临床推广应用.

A comparative study of the open and percutaneous operation for thoracolumbar fractures respectively

Objective]To compare the clinical outcomes of the treatment of thoracolumbar vertebra fracture by open operation and percutaneous operation.Method]Twenty-one cases with thoracolumbar vertebra fracture undwent percutaneous operation and 28 cases underwent open operation from April 2006 to December 2008.Perioperative parameter,postoperative imaging index,visual analog scale(VAS) were compared.EMG were adopted for evaluation at half-year after operation.Result]All cases were followed up from 6 to 31 months(mean 13 months).The surgical time between two groups showed no significant difference,but the bleeding of operation,spending of hospitalization,pain of postoperation(VAS scores) were siginificantly different.In each group,comparison of anterior vertebra height,Cobb's angle,the occupation index of vertebral canal between pre and post operation were all significantly different,but compared to each other,there weren't significant difference. Serum level of Creatinine Kinase in percutaneous operation group was less than open operation group.Fibrillation potentials was found in open operation group,but not found in percutaneous operation group.Conclusion]The technique of minimally invasive percutaneous operation has the advantages of less trauma and bleeding,less paraspinal muscle injury,quick recovery,light pain.It is worth to be used wildly.