两种微创手术方式治疗胸腰椎骨折的疗效比较

目的:探讨经改良Wiltse入路微创小切口与Sextant经皮椎弓根螺钉内固定术治疗单节段、无神经症状胸腰椎骨折的临床疗效。方法:收集2017年1月至2020年4月在南京医科大学第一附属医院手术治疗的60例单节段无神经症状的胸腰椎骨折患者，将60例病例随机分为经改良Wiltse入路微创小切口组(A组)和Sextant经...

Comparison of small-incision internal fixation via modified wiltse approach and sextant percutaneous fixation in the treatment of thoracolumbar fractures

Objective To compare the efficacy of two different minimally invasive operations(small-incision internal fixation via modified wiltse approach and sextant percutaneous fixation)in the treatment of single-segment thoracolumbar fractures without neurologic symptoms.Methods A total of 60 cases who suffered from single-segment thoracolumbar fractures without neurologic symptoms from Jan.2017 to Apr.2020 were collected.All cases were divided into two groups:30 cases in group A receiving small-incision internal fixation,and the rest in group B undergoing Sextant percutaneous fixation.Time of intraoperative radiation exposure,hospital stay,operation time,Cobb’s angle,ratio of anterior vertebral height and visual analogue scale(VAS)in group A and group B were compared by Student’s t test.Results All patients were followed up for one year.No neurologic injuries,infection,broken and loose nails were observed.Time of intraoperative radiation exposure in group A and group B was(1.06±0.44)s and(5.29±1.80)s,respectively(t=-11.563,P<0.05).Hospital stay in group A and group B was(10.30±3.52)d and(10.27±3.44)d,respectively(t=0.032,P>0.05).The operation time in groups A and B was(97.80±17.93)min and(88.93±22.72)min,respectively(t=1.734,P>0.05).The Cobb’s angle before,3 days and 6 months after operation in group A was(11.90±2.97)°,(4.44±1.08)°,(5.32±1.06)°,respectively,and that in group B was(11.79±2.60)°,(4.31±1.01)°,(5.55±1.18)°,respectively(t=0.159,P>0.05).The ratio of anterior vertebral height before,3 days and 6 months after operation in group A was(57.57±5.00)%,(90.47±1.47)%,(89.09±2.69)%,respectively,and that in group B was(57.13±5.64)%,(89.57±1.97)%,(87.57±2.47)%,respectively(t=0.307,0.861,1.359,P>0.05).The VAS score before,3 days and one week after operation in group A was(7.90±0.71),(3.00±0.79)and(1.67±0.61),respectively,and that in group B was(7.77±0.68),(3.57±0.73)and(1.90±0.61),respectively(P>0.05).These five parameters(hospital stay,operation time,Cobb’s angle,ratio of anterior vertebral height and VAS score)before,3 days and one week after operation between two groups showed no statistically significant difference(t=0.701,-1.084,-1.564,P>0.05).The ratio of anterior vertebral height was improved significantly at 3 days and 6 months after surgery,and so were the VAS score(for group A:t=23.233,36.505;for group B:t=30.224,37.348,P<0.05).Conclusion Minimally invasive operation has the advantage of shorter operating time,less bleeding,less injury and quicker recovery.Compared with Sextant percutaneous fixation,small-incision internal fixation can noticeably reduce radiation exposure in operation and diminish the long-term residuary back pain after surgery.It is an ideal choice to treat single-segment thoracolumbar fractures without neurologic symptoms.