改良金属网格定位器经皮微创椎弓根螺钉内固定术治疗无神经症状胸腰椎骨折

目的　比较改良金属网格定位器经皮微创和传统后路开放椎弓根螺钉内固定术治疗无神经症状的单椎体胸腰椎骨折的临床疗效。方法回顾性分析2014年1月—2017年12月收治的50例无神经症状的单椎体胸腰椎骨折患者临床资料,其中采用改良金属网格定位器经皮微创椎弓根螺钉内固定术治疗25例(微创组),采用传统后路开放椎弓根螺钉内固定术治疗25例(开放组)。记录2组切口总长度、手术时间、术中出血量、置钉准确率及并发症发生情况,测量X线片上伤椎前缘高度及Cobb角,评估恢复及矫正情况,采用改良MacNab标准评价疗效。结果所有手术顺利完成,患者随访12 ～ 21(16.1±2.4)个月。微创组切口总长度、手术时间、术中出血量均明显优于开放组,差异均有统计学意义(P 0.05);微创组置钉准确率为95%,开放组置钉准确率为94%,组间差异无统计学意义(P 0.05)。2组患者术后1周、末次随访时伤椎前缘相对高度及Cobb角均较术前明显改善,差异有统计学意义(P 0.05),组间比较差异无统计学意义(P 0.05)。末次随访时改良MacNab疗效评定:微创组优15例,良8例,可2例,优良率为92%;开放组优13例,良9例,可3例,优良率为88%;组间差异无统计学意义(P 0.05)。微创组1例腰背部出现皮下血肿,嘱患者仰卧位并对症治疗后血肿自行吸收;其余患者未发生类似情况及其他相关并发症。结论改良金属网格定位器经皮微创椎弓根螺钉内固定术治疗无神经症状的单椎体胸腰椎骨折疗效与传统后路开放手术相当,且具有创伤小、手术时间短、出血量少的优点,改良金属网格术中定位准确率高,值得临床推广。

Treatment of thoracolumbar fractures without neurological symptoms by minimally invasive percutaneous pedicle screw internal fixation with modified metal grid locator

Objective To compare the clinical efficacy of minimally invasive percutaneous pedicle screw internal fixation by modified metal grid locator and traditional posterior open pedicle screw internal fixation for treatment of single-segment thoracolumbar fractures without neurological symptoms. Methods From January 2014 to December 2017,the clinical data of 50 patients who suffered from single-segment thoracolumbar fractures without neurological symptoms were retrospectively analyzed. Among them,25 cases were treated with minimally invasive percutaneous pedicle screw internal fixation assisted by modified metal grid locator(minimally invasive group),and 25 with traditional posterior open pedicle screw internal fixation(open group). The total incision length,operation time,intraoperative blood loss,accuracy rate of pedicle screw placement and complications of the 2 groups were recorded. The recovery of the anterior vertebral height and the correction of Cobb''s angle were measured on anterior roentgenograph. The modified MacNab criteria was used to evaluate clinical efficacy. Results All the operations were completed successfully. All the patients were followed-up for 12-21(16.1±2.4)months. The total incision length,operation time and intraoperative blood loss in the minimally invasive group were significantly lower than those in the open group,with statistically significant differences(P<0.05). The accuracy rate of pedicle screw placement was 95% in the minimally invasive group,while that was 94% in the open group. There was no significant difference between the 2 groups(P>0.05). The anterior vertebral height and Cobb''s angle were significantly improved at postoperative 1 week and the final follow-up,and the differences were statistically significant(P<0.05);but there was no statistically significant difference between the 2 groups(P>0.05). According to modified MacNab criteria,excellent and good outcome rate was 92% at the final follow-up in the minimally invasive group(excellent in 15,good in 8 and fair in 2);excellent and good outcome rate was 88% at the final follow-up in the open group(excellent in 13,good in 9 and fair in 3). There was no statistically significant difference between the 2 groups(P>0.05). Subcutaneous hematoma occurred in the lower back in 1 patient in the minimally invasive group. The patient was instructed to lie on his back and received symptomatic treatment,and the hematoma was absorbed. Other patients had no similar situation and other complications. Conclusion Both minimally invasive percutaneous pedicle screw internal fixation assisted by modified metal grid locator and traditional posterior open pedicle screw internal fixation have good clinical efficiency for single-segment thoracolumbar fractures without neurological symptoms. But the minimally invasive internal fixation has the advantages of small trauma,shorter operation time and less blood loss,and the modified metal grid locator has high intraoperative accuracy,thus being worthy of wider clinical application.