导航辅助微创手术与传统开放手术治疗胸腰段脊柱骨折的对照研究

目的 比较术中计算机辅助微创脊柱外科手术(CAMISS)与传统后正中人路切开复位内固定手术治疗胸腰段脊柱骨折临床疗效的差别.方法 本研究为前瞻性随机对照研究,包括2006年1月至2011年3月所有接受胸腰段骨折复位内固定手术的病例,采用随机数字表的方法分配,随机进行CAMISS治疗或传统开放手术治疗.通过比较CAMISS与传统开放手术的各种参数,包括手术时间,估计失血量,术前、术后72 h腰背痛视觉模拟评分(VAS),置钉准确性,后凸畸形程度、矫正及保持情况等,评估两种手术方法的优劣.结果 接受CAMISS治疗的患者47例(CAMISS组),接受传统开放手术治疗的患者50例(对照组).患者随访3～50个月,平均12个月.两组患者术前临床资料包括年龄、性别、婚姻状况、职业特点、受伤机制、骨折分型、术前手术节段Cobb角、术前骨折椎自身Cobb角、术前腰背痛VAS评分差异均无统计学意义(P＞0.05).CAMISS组患者与对照组相比,置钉准确性较高、出血量减少、下床活动时间较早、术后发热程度较低、术后72 h腰背痛VAS评分得到更好的恢复(t=2.162 ～8.736,P＜0.05).CAMISS组患者与对照组相比,术后手术节段Cobb角改善程度(10.9°±5.5°比13.8°±6.8°)及术后骨折椎自身Cobb角改善程度(7.7°±4.8°比11.0°±6.0°)均较低(t=2.108和2.610,P＜0.05),但两组患者于术后、随访时的手术节段Cobb角及骨折椎自身Cobb角的差异均无统计学意义(P＞0.05).结论 CAMISS具有创伤小、出血少、恢复快、置钉准确性高的特点,对伤椎畸形的矫正和内固定效果与传统开放手术相当.

The comparison of computer assisted minimally invasive spine surgery and traditional open treatment for thoracolumbar fractures

Objective To compare the clinical results between computer assisted minimally invasive spine surgery (CAMISS) and traditional open fixation surgery which used in thoracolumbar fractures.Methods A prospective randomized controlled trial of patients who had undergone surgery for thomcolumbar fracture from January 2006 to March 2011 was performed.The patients were randomly divided into CAMISS group and traditional open treatment group (control group) by random number table.Clinical results were assessed by comparing the following parameters between patients who had undergone CAMISS or traditional open surgery:operative time,estimated blood loss,visual analogue scale(VAS) of the low back pain,the accuracy of pedicle screw,the status and the correction of kyphosis.Results Forty-seven patients underwent CAMISS,and fifty patients underwent traditional open surgery.The follow-up periods were 3-50 months (mean 12 months).According to the preoperative data,the two groups did not differ with respect to age,gender,marriage,occupation,mechanism of injury,classification of fracture,preoperative VAS scores of the low back pain,preoperative functional spine unit(FSU) Cobb's angle and preoperative local angle of the fracture vertebral body ( P ＞ 0.05 ).Compare to the control group,the patients who got CAMISS had more accuracy of pedicle screw,less blood loss,short immobilized time,lower postoperative fever,and better VAS score of the low back pain ( t =2.162-8.736,P ＜ 0.05 ).The improvement of FSU Cobb's angle and local angle of the fracture vertebral body were better at control group after operation (13.8° ±6.8°vs.10.9° ±5.5°,11.0° ±6.0°vs.7.7° ±4.8°,t =2.108 and 2.610,P ＜0.05).But there was no significantdifference of the FSU Cobb's angle,or local angle of the fracture vertebral body between the two groups at post-operation and follow-up (P ＞ 0.05 ).Conclusions CAM ISS has the characteristics of fewer traumas,less bleeding,faster recovery,high accuracy of pedicle screws.It has comparable vertebral deformity correction and fixation result of the traditional open operation.