经皮椎弓根钉内固定治疗胸腰椎骨折

目的通过与开放椎弓根钉内固定手术相比较,探讨经皮微创普通椎弓根钉内固定辅助系统治疗胸腰椎骨折的临床效果。方法自2008年1月至2012年12月将86例胸腰椎骨折随机分为两组(n=43),分别采用经皮普通椎弓根钉内固定(微创组)和开放椎弓根钉内固定(开放组)治疗胸腰椎骨折,比较两组伤椎前缘高度比值、矢状面Cobb角、手术时间、出血量及并发症等情况。结果术后所有患者随访6~48个月,平均18.6个月。微创组伤椎前缘高度比值平均从术前(47.5±8.6)%恢复至术后(90.3±5.8)%,Cobb角平均从术前(17.6±6.20)°恢复至术后(2.0±1.30)°,微创组术后伤椎前缘高度比值与开放组(91.7±5.0)%相比较差异无统计学意义(P0.05),微创组术后伤椎矢状面Cobb角与开放组(1.9±1.20)°相比较差异无统计学意义(P0.05),微创组手术时间平均(94.0±21.3)min,与切开组(98.5±16.5)min比较差异无统计学意义(P0.05)。微创组术中出血量平均(54.4±12.6)mL,与切开组(289.1±20.5)mL比较差异有统计学意义(P0.05)。除开放组1例出现切口感染外,两组未出现其他手术相关并发症。结论经皮普通椎弓根钉内固定辅助系统治疗胸腰椎骨折与开放性椎弓根钉内固定手术相比创伤小,出血少,患者恢复快,可达到开放复位同样的疗效。

The Application of Auxiliary System for Percutaneous Pedicle Screws Osteosynthesis on the Treat-ment of Thoracolumbar Vertebra Fracture

Objective To compare the clinical effect of minimally invasive percutaneous pedicle screws osteosynthesis （MIPPSO）with traditional open pedicle screws osteosynthesis（ TOPSO）in the treatment of thoracolumber vertebra fracture. Methods 86 consecutive inpatients with severe thoracolumbar vertebra fractures from JAN 2008 to DEC 2012 were divded randomly into two groups,MIPPSO group and TOPSO group respectively. The image result,operative time,intraoperative blood loss,and clinical outcomes were compared between the two groups. Results All of the patients had been completely followedup for 6 to 48 month（s average 18. 6 months）. There were no significant difference in the recovery rate of vertebral height and sagittal cobb angle between MIPPSO group and TOPSO group（P ﹥0. 05）. The rate of vertebral height and sagittal cobb angle were both significantly differen（t P ﹤0. 05）before and after operation. There was no significant difference in operative time between the two groups（P ﹥0. 05）. Intraoperative blood loss was significantly different between MIPPSO group（54. 4 ± 12. 6） mL and TOPSO group（289. 1 ±20. 5）mL（P ﹤0. 05）. There were no surgery-related complications in the two groups,except a case of wound infection found in TOPSO group. Conclusion The self-made auxiliary system for minimally invasive percutaneous pedicle screws osteosynthesis is very useful,it not only can achieve the same clinical effect with open surgery,but aslo has the advantages of less trauma and bleeding.