开放手术与微创手术治疗胸腰椎骨折的疗效对比

目的探讨常规后路开放经伤椎椎弓根螺钉内固定术、微创手术(小切口内固定术和经皮Sextant内固定术)治疗无神经症状胸腰椎骨折的临床疗效。方法回顾性分析南京医科大学附属第一医院骨科2013年5月~2014年8月收治的单节段无神经症状胸腰椎骨折患者临床资料90例,比较并分析不同手术组的围手术期参数、临床疗效及影像学检查等指标。根据术式将90例病例资料分为常规后路开放经伤椎椎弓根螺钉内固定术组(A组,30例)、经Wiltse入路小切口内固定术组(B组,30例)及经皮Sextant内固定术组(C组,30例)。结果 90例患者均获得随访,随访时间为1年,无脱钉、断钉及神经损伤现象。B、C组在手术切口长度、术中出血量、手术时间、住院时间方面优于A组,差异具有统计学意义(P0.05);B组手术时间、术中X线暴露时间和住院费用优于C组,差异具有统计学意义(P0.05)。3组术后伤椎椎体前缘相对高度、后凸Cobb角与术前比较,差异具有统计学意义(P0.05),但3组之间比较差异无统计学意义(P0.05)。B、C组术后视觉模拟量表(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)均优于A组,差异具有统计学意义(P0.05)。结论与开放手术相比,微创手术(小切口内固定术和经皮Sextant内固定术)治疗胸腰椎骨折能取得同样的疗效,且具有创伤小、出血少、恢复快、安全性高的优点。小切口内固定术相比经皮Sextant内固定术,又有手术时间短、放射透视少、价格低廉等优点,更适合在基层医院开展,在严格掌握手术适应证情况下,是治疗无神经损伤胸腰椎骨折的理想选择。

Comparison of traditional open operation and minimally invasive surgical for treatment of thoracolumbar fracture

Objective To compare the effect of conventional pedicle screw fixation operation via fracture vertebra and minimally invasive surgery (small-incision internal fixation and Sextant percutaneous fixation) on the treatment of thoracolumbar fracture without nerve symptoms. Methods From May 2013 to August 2014, 90 cases who suffered from single-level thoracolumbar fracture without neurological symptoms and underwent surgical operation were selected. Perioperative parameters, clinical outcomes and radiographic examination outcomes were analyzed. All the cases were divided into 3 groups: 30 cases in Group A underwent a conventional pedicle screw fixation operation via fracture vertebra with open operation; 30 cases in Group B took small-incision internal fixation via Wiltse approach; 30 cases in Group C underwent Sextant percutaneous fixation. Results All the cases were followed up for 1 year. No nails removing, nail breaking and nerve injury were observed. The incision length, blood loss, operation time and length of stay in hospital of Group B and C were notablely better than those of Group A. The difference was statistically significant(P<0.05).The operation time, intraoperative X-ray perspective time and hospital costs in Group B were remarkablely less than those of Group C. The difference was statistically significant(P<0.05). The relative height of anterior border and Cobb's angle were significantly better than those of pre-operation in 3 groups. However, there was no difference among 3 groups at postoperation. The visual analogue scale(VAS) scores and Oswestry disability index(ODI) in Group B and C were much better than those of Group A. The difference was statistically significant(P<0.05). Conclusion Compared with the traditional open surgery, minimally invasive surgery (small-incision internal fixation and Sextant percutaneous fixation) can obtain the same imaging result. Besides, minimally invasive surgery has the advantages of minimal injury, less bleeding, quick recovery and high safety. Small-incision internal fixation via Wiltse approach has the advantages of shorter operation time, less radiation perspective and cheaper compared with Sextant percutaneous fixation, so it is very suitable for development in the primary hospital. Small-incision internal fixation is a better choice for the treatment of thoracolumbar fracture without nerve symptoms in the case of strictly surgical indications.