手术室微创椎弓根钉内固定术中不同入路法对胸腰椎创伤性骨折患者伤椎有效性指标的影响

目的:对比不同入路法微创椎弓根内固定术治疗胸腰椎创伤性骨折的价值。方法:选取医院收治的90例胸腰椎创伤性骨折患者,根据手术治疗中入路方法的不同将其分别纳入经皮入路组、Wiltse入路组和后正中入路组,每组30例。所有患者均行椎弓根钉内固定手术治疗,对比三组患者术中失血量、手术时间和术后引流量;评价患者术前和术后1 d、1周及8周视觉模拟量表(VAS)评分、患者伤椎Oswestry功能障碍指数(ODI)、伤椎前缘高度比及伤椎后凸Cobb角指标改善情况。结果:Wiltse入路组患者手术时间短于经皮入路组和后正中入路组,三组比较差异有统计学意义(F=92.783,P<0.05);经皮入路组术中失血量、术后引流量低于Wiltse入路组和后正中入路组,三组比较差异有统计学意义(F=185.964,F=75.620;P<0.05);术后1 d、1周及8周,三组患者VAS评分均较术前呈下降趋势,依次为经皮入路组、Wiltse入路组和后正中入路组,三组术前与术后各时点组间比较,差异有统计学意义(F=35.129,P<0.05)。术后1周、术后8周,三组ODI指数、伤椎后凸Cobb角较术前均呈下降趋势,伤椎前缘高度比呈升高趋势。结论:经手术室微创椎弓根钉内固定手术治疗胸腰椎创伤性骨折中,经Wiltse入路操作更简单方便,组织损伤少,术中透视少,利于缩短手术时间,且术中出血量及术后引流量较少,患者术后伤椎整体恢复效果更好,可作为入路首选。

Effect of different approaches of minimally invasive pedicle screw internal fixation in operating room on the effective indexes of injured vertebrae in patients with thoracolumbar vertebral traumatic fracture

Objective:To compare the value of different approaches of minimally invasive pedicle screw internal fixation in treatment of thoracolumbar vertebral traumatic fracture.Methods:90 patients with thoracolumbar vertebral traumatic fracture in the hospital were selected.According to different approaches in surgery,the patients with percutaneous approach during surgery were included in percutaneous approach group,and the patients with Wiltse approach were included in Wiltse approach group,and the patients with posterior median approach were included in posterior median approach group,with 30 cases in each group.All the patients underwent the treatment with pedicle screw internal fixation.The intraoperative bleeding volume,operation time and postoperative drainage volume among the three groups were compared.The preoperative visual analogue scale(VAS)scores,the postoperative VAS scores at 1th d,1th w and 8th w,Oswestry disability index(ODI)about injured vertebrae of patients,the height ratio of fractured vertebrae at front edge and the improvement of kyphosis Cobb angle of fractured vertebrae were evaluated.Results:The operation time of Wiltse approach group was significantly shorter than that of percutaneous approach group and posterior median approach group(F=92.783,P<0.05).The intraoperative bleeding volume and postoperative drainage volume of percutaneous approach group were significantly lower than those of Wiltse approach group and posterior median approach group(F=185.964,F=75.620,P<0.05).Compared with preoperative VAS scores,the postoperative VAS scores at 1th d,1th w and 8th w of the three groups showed the decreased trend,and the successive sequence of them was percutaneous approach group,Wiltse approach group and posterior median approach group.And the differences of three groups among preoperative VAS scores and postoperative VAS scores at each time point were significant(F=35.129,P<0.05).Compared preoperative ODI and kyphosis Cobb angle of fractured vertebrae of three groups,those of three groups postoperative 1th w and 8th w appeared decreased trend,while the height ratio at front edge of fractured vertebra of three groups showed the increased trend.Conclusion:During minimally invasive pedicle screw internal fixation in operating room in treatment of thoracolumbar vertebral traumatic fracture,the operation of Wiltse approach is simpler and more convenient,and it has less tissue damage and intraoperative fluoroscopy.The Wiltse approach can shorten the operation time,and it has less intraoperative bleeding volume and postoperative drainage volume,and it achieves better overall recovery effect for injured vertebrae of patients.Therefore,it can be used as the preferred approach.