经皮单向实心椎弓根钉内固定术与椎弓根螺钉固定术治疗胸腰椎骨折患者的疗效比较

Percutaneous one-way solid pedicle screw fixationversus pedicle screw fixation in treating patients with thoracolumbar fracture

  • 摘要:
      目的  比较经皮单向实心椎弓根钉内固定术与椎弓根螺钉固定术治疗胸腰椎骨折患者的疗效。
      方法  选取67例胸腰椎骨折患者,分为微创组35例与常规组32例,微创组使用经皮单向实心椎弓根钉内固定术,常规组使用椎弓根螺钉固定术。比较2组患者手术时间、术中出血量、引流量、肌酸激酶水平、下床时间。比较2组患者不同时点视觉模拟评分法(VAS)评分和功能障碍指数法(ODI)评分,比较2组患者病变椎体前缘高度比较值及Cobb角。
      结果  微创组手术时间、术中出血量、术后引流量、下床时间、术后1 d肌酸激酶水平均显著优于常规组(P < 0.05)。2组患者术前VAS评分无显著差异(P>0.05)。术后1周时,常规组VAS评分显著高于微创组(P < 0.05)。术后1个月时,常规组VAS评分略高于微创组,差异无统计学意义(P>0.05)。2组患者均在术前基本丧失行为能力, ODI评分比较差异无统计学意义(P>0.05)。术后3个月,微创组ODI评分显著低于常规组(P < 0.05)。术后6个月, 2组患者均已恢复行为能力, ODI评分比较差异无统计学意义(P>0.05)。术前、术后6个月, 2组患者椎体前缘高度比较值、Cobb角差异均无统计学意义(P>0.05)。术后3个月时, 2组患者椎体前缘高度比较值差异无统计学意义(P>0.05), 但微创组Cobb角显著大于常规组(P < 0.05)。
      结论  相对于常规椎弓根螺钉固定术,经皮单向实心椎弓根钉内固定术具有手术时间短、出血量少、恢复快等优势,但二者最终疗效无明显差异。

     

    Abstract:
      Objective  To compare the effect of percutaneous one-way solid pedicle screw fixation and pedicle screw fixation in the treatment of patients with thoracolumbar fracture.
      Methods  Totally 67 patients with thoracolumbar fracture were divided into minimally invasive group (n=35) and conventional group (n=32). Minimally invasive group was treated with percutaneous one-way solid pedicle screw fixation, while conventional group was treated with pedicle screw fixation. The operation time, intra-operative bleeding volume, drainage volume, creatine kinase level and time of getting out of bed were compared between the two groups. Visual analogue scale (VAS) and dysfunction index (ODI) scores at different time points were compared between the two groups, and the comparison value of anterior vertebral height and Cobb angle were compared between the two groups.
      Results  The operation time, intra-operative bleeding volume, postoperative drainage volume, time to get out of bed and the level of creatine kinase at 1st day after operation in the minimally invasive group were significantly better than those in the conventional group (P < 0.05). There was no significant difference in preoperative VAS score between the two groups (P>0.05). At 1 week after operation, the VAS score of conventional group was significantly higher than that of minimally invasive group (P < 0.05). At 1 month after operation, the VAS score of conventional group was slightly higher than that of minimally invasive group (P>0.05). There was no significant difference in ODI score between the two groups (P>0.05). Three months after operation, the ODI score of the minimally invasive group was significantly lower than that of the conventional group (P < 0.05). Six months after operation, patients in both groups had recovered with behavioral ability, and there was no significant difference in ODI score (P>0.05). There was no significant difference in the comparison value of anterior vertebral height and Cobb angle between the two groups before and 6 months after operation (P>0.05). At 3 months after operation, there was no significant difference in the comparison value of anterior vertebral height between the two groups (P>0.05), but the Cobb angle in the minimally invasive group was significantly higher than that in the conventional group (P < 0.05).
      Conclusion  Compared with the pedicle screw fixation, the percutaneous one-way solid pedicle screw fixation has the advantages of shorter operation time, less bleeding and faster recovery, but there is no significant difference in the final efficacy between the two types of operation.

     

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