经皮与开放椎弓根螺钉固定治疗胸腰椎骨折的比较研究

目的比较经皮椎弓根螺钉内固定与开放切开椎弓根螺钉内固定治疗无神经症状胸腰椎爆裂性骨折的临床疗效。方法回顾分析60例无神经症状的胸腰椎爆裂性骨折手术患者,其中微创经皮组和开放切开组各30例患者。比较两组围手术期参数、影像学指标、视觉模拟疼痛评分及Oswestry功能障碍指数。结果经皮组与开放切开组在术中出血量、术后引流量、住院日均有显著性差异（P〈0．05）,而在手术时间上无明显差异（P〉0．05）,术前、术后及随访影像学观察椎体前缘高度、后凸Cobb角、矢状面指数及椎管堵塞指数等恢复无显著性差异（P〈0．05）;两组疼痛评分在术后和术后3个月内有显著性差异（P〈0．05）,但3个月以后评分无显著性差异。2年随访时两组功能评分无显著性差异（P〉0．05）。结论经皮椎弓根螺钉内固定是治疗无神经症状胸腰椎骨折的理想微创手术方法,但远期疗效与传统开放手术相近。

Comparative percutaneous with open pedicle screw fixation in the treatment of thoracolumbar burst fractures without neurological deficit

OBJECTIVE: To compare clinical outcome of the percutaneous versus open pedicle screw fixation in the treatment of thoracolumbar burst fracture with neurological intact. METHODS: Sixty patients with thoracolumbar burst fracture without neurological deficit underwent either percutaneous (n = 30) or traditional open pedicle screw fixation (n = 30). Radiographs obtained before surgery, immediately after surgery, 4 months and 2 years after surgery were used to access the restoration of spinal anatomy. Also, operation time, blood loss, blood drainage, hospital stay and soft tissue dissection were evaluated. The level of pain was assessed by visual analog scale (VAS), function by the Oswestry questionnaire. RESULTS: The average followed up was 2 years. There were no significant differences between both groups concerning age, sex, cause of injury and the presence of other severe injuries. Significant differences were observed between the two groups in blood loss, blood drainage, hospital stay and soft tissue dissection (P < 0.01), whereas no significant differences in operation time (P > 0.05). The vertebral height, the kyphosis angle, and the occupation of spinal canal after surgery and at follow-up were not significantly (P > 0.05). The pain systems and functions were similar in both groups at final follow-up (P > 0.05), however, less pain was found in the percutaneous group than that in the open group at the first 3 months after surgery (P < 0.01). CONCLUSION: Pecutanoeus pedicle screw fixation for thoracolumbal frcture has the advantage of less trauma, quickly recovery and better esthetic outcome, however, it has the same results with the traditional open produce after 2 years of surgery.