后路腰椎间盘镜(MED)辅助胸腰椎椎弓根螺钉置钉技术的可行性、安全性和临床疗效观察

目的观察后路腰椎间盘镜(MED)辅助胸腰椎椎弓根螺钉置钉技术的可行性、安全性和临床疗效。方法笔者医院2012年1月~2014年1月期间接诊的80例胸腰椎骨折行单纯微创椎弓根螺钉内固定患者作为研究对象,将其随机分为两组,每组40例。两组均进行常规检查,对照组患者用Sextant系统经皮穿刺置入空心椎弓根螺钉进行治疗,研究组用MED下置入普通椎弓根螺钉进行治疗,记录两组患者的手术时间、术中出血量、切口长度、透视次数、操作方便性等各指标值以及两组患者的TLICS评分、VAS评分、JOA评分、并发症发生率、住院时间、住院费用、治疗后满意度等术后情况,并对其结果进行比较分析。结果两组患者在手术时间、术中出血量、TLICS评分、VAS评分、住院时间以及切口长度等指标方面均没有明显的差异,无统计学意义(P0.05);研究组住院费用明显低于对照组患者,差异具有统计学意义(P0.05)。研究组患者的并发症发生率为5.0%,对照组为7.5%,差异无统计学意义(P0.05);经过治疗,研究组患者的总满意度为92.5%,而对照为75.0%,差异显著。术前两组患者的JOA评分没有明显差异,无统计学意义(P0.05);术后两组患者JOA评分均有明显的变化,且研究组患者的变化程度明显大于对照组患者,差异显著,具有统计学意义(P0.05)。结论 MED辅助胸腰椎椎弓根螺钉治疗胸腰椎骨折可以明显改善患者的胸腰椎功能,降低了手术的风险,患者满意度较高,安全性更高,具有临床应用价值,值得推广。

The study of the feasibility,safety and clinical efficacy of microendoscopic discectomy(MED) assisted thoracolumbar pedicle screw placement technology

Objective To observe the feasibility ,safety and clinical efficacy of microendoscopic discectomy ( MED) assisted thoracolumbar pedicle screw placement technology .Methods Eighty patients with thoracolumbar fractures received simple minimally invasive pedicle screw fixation in our hospital from Jan .2012 to Jan.2014 peri-od were selected as research subjects .They were randomly divided into two groups with 40 patients in each group . Patients in the two groups underwent routine examination .The control group was treated by percutaneous hollow pedicle screw implantation with Sextant system ,while the study group was treated with MED assisted ordinary pedicle screw implantation.The operation time,intraoperative blood loss,length of incision,exposure times,ease of opera-tion,TLICS score,VAS score,JOA score,complication rates,length of stay,hospital cost,treatment satisfaction after surgery were recorded and compared between the two groups .Results Operation time,blood loss,TLICS score, VAS score,and the length of hospital stay between the two groups were compared , and the difference was not statisti-cally significant ( P>0.05 ) .The hospital cost of the study group was significantly lower than that of the control group,and the difference was statistically significant ( P<0.05).Complication incidence of the study group was 5.0%,while that in the control group was 7.5%,the difference was not statistically significant (P>0.05).After treatment,the total satisfaction rate of the study group was 92.5%,while total satisfaction rate in the control group was 75.0%,the difference was significant .Before surgery ,JOA score of the two groups was not significantly different (P>0.05).After surgery,both groups had significant changes in JOA score ,and the degree of change in the study group was significantly higher than that in the control group with significant difference (P<0.05).Conclusion MED assisted thoracolumbar pedicle screw placement in the treatment of thoracolumbar fractures can significantly re -duce the times of exposure and the cost of treatment .It can make the surgical procedure easier and greatly reduce the risk of surgery .It is safe with high clinical value ,and worthy of promotion .