微创与开放椎弓根螺钉内固定治疗胸腰椎骨折的疗效对比

目的比较微创经皮椎弓根螺钉内固定与传统开放椎弓根螺钉内固定治疗无神经症状胸腰椎骨折的临床疗效。方法 2006年4月~2010年4月,收治28例无神经系统症状的胸腰椎骨折患者,其中12例行微创经皮椎弓根螺钉内固定术,16例行传统开放椎弓根钉内固定术。比较两组的围手术期相关指标、影像学指标、Oswestry功能障碍指数。结果微创组与开放组的手术时间、术中出血量、术后引流量、手术切口长度、术后VAS疼痛评分相比,微创组明显低于开放组,差异均有统计学意义（均P〈0.05）;两组的术中X线透视时间比较差异无统计学意义（P〉0.05）。术后两组的Cobb＇s角、椎体前缘高度比较差异均无统计学意义（均P〉0.05）。两组术后的Cobb＇s角、椎体前缘高度与同组术前比较,均有高度统计学意义（均P〈0.01）。术后1年,两组的Cobb＇s角、椎体前缘高度比较差异均无统计学意义（均P〉0.05）。术后半年两组的Oswestry功能障碍指数比较差异无统计学意义（P〉0.05）。结论微创经皮椎弓根螺钉内固定治疗胸腰椎骨折,操作简便、创伤小、出血少、恢复快,复位效果好。

Comparative study of minimally invasive and open pedicle screw fixation in the treatment of thoracolumbar fractures

Objective To compare clinical outcomes of minimally invasive versus open pedicle screw fixation in the treatment of thoracolumbar fracture with intact neurology.Methods From April 2006 to April 2010,12 cases with thoracolumbar vertebra fracture without neural impairment underwent minimally invasive pedicle screw fixation,and 16 cases underwent open operation.Perioperative parameters,postoperative imaging index,Oswestry disability Index were compared.Results Significant differences were observed between the two groups in operation time,blood loss,blood drainage,incision size and VAS score(P <0.05).The perspective time between two groups showed no significant difference(P >0.05).In each group,comparison of anterior vertebral height,Cobb′s angle before and after operation were significantly different(P <0.01),but compared to each other,there were not significant differences(P > 0.05).One year after operation,there were no significant differences in vertebral height and the kyphotic angle between the two groups.6 months after operation,Oswestry Disability Index were similar in the two groups.Conclusion Minimally invasive pedicle screw treatment for thoracolumbar fracture with intact neurology has the advantages of simple manipulation,quick recovery,limited trauma and less blood loss.It can well restore the height of injured vertebra.