不同入路椎弓根螺钉内固定术对胸腰椎骨折患者的影响比较

汪凡栋; 郑佳状; 陈宇; 宋昭君; 刘元彬; 唐龙; 王淼; 周永; 刘会毅

doi:10.7619/jcmp.20232471

不同入路椎弓根螺钉内固定术对胸腰椎骨折患者的影响比较

Effects of pedicle screw internal fixation via different approaches in patients with thoracic and lumbar fractures

摘要

摘要:
目的比较改良Wiltse入路椎弓根螺钉内固定术与经皮椎弓根螺钉内固定术对AO分型B型胸腰椎骨折患者应激反应、腰背功能恢复等的影响效果。
方法采用随机数表法将103例AO分型B型胸腰椎骨折患者分为经皮组(采用经皮椎弓根螺钉内固定术)51例与改良组(采用改良Wiltse入路椎弓根螺钉内固定术)52例，比较2组手术情况、腰背功能恢复情况术前、术后1个月、术后3个月评估Oswestry功能障碍指数(ODI)评分、应激反应术前、术后3 d检测血清皮质醇(Cor)、肾上腺素(E)与肌酸激酶(CK)水平、影像学检查相关指标术前、术后1年检测椎后凸Cobb角、伤椎椎体前缘高度比(AVHR)和疼痛程度术前、术后1周、术后1个月评估视觉模拟评分法(VAS)评分。
结果改良组手术时间、术中透视时间均短于经皮组，术中出血量少于经皮组，差异有统计学意义(P < 0.05); 术后1、3个月时, 2组ODI评分均低于术前，且改良组低于经皮组，差异有统计学意义(P < 0.05); 术后3 d时, 2组血清Cor、E、CK水平均高于术前，但改良组血清Cor、E、CK水平均低于经皮组，差异有统计学意义(P < 0.05); 术后1年时, 2组Cobb角小于术前, AVHR大于术前，且改良组AVHR大于经皮组，差异有统计学意义(P < 0.05); 术后1周、1个月时, 2组VAS评分均低于术前，且改良组低于经皮组，差异有统计学意义(P < 0.05)。
结论相较于经皮椎弓根螺钉内固定术，改良Wiltse入路椎弓根螺钉内固定术治疗AO分型B型胸腰椎骨折有利于缩短手术时间、术中透视时间，减轻机体应激反应，对促进患者术后腰背功能与生理解剖结构恢复和减轻疼痛程度具有重要意义。

Abstract:
Objective To compare the effects of modified Wiltse approach and percutaneous pedicle screw fixation on stress response and function recovery of waist and back in patients with type B (AO type) thoracolumbar fracture.
Methods A total of 103 with thoracolumbar type B fractures were randomly divided into percutaneous group (51 cases, percutaneous pedicle screw technique) and modified group (52 cases, pedicle screw fixation via modified Wiltse approach), and the operation situation and the recovery of waist and back evaluated by Oswestry dysfunction index (ODI) before operation, one month and three months after operation, stress response serum cortisol (Cor), adrenaline (E) and creatine kinase (CK) were detected before and 3 days after operation, related indexes of imaging examinationCobb angle of kyphosis and height ratio of anterior edge of injured vertebral body (AVHR) before and one year after operationand pain degreeby Visual Analogue Scale (VAS) before operation, 1 week and 1 month after operation.
Results Compared with the percutaneous group, the operation time and perioperative fluoroscopy time in the modified group were shorter, and the blood loss during the operation was less (P < 0.05); the ODI scores at 1 month, 3 months after surgery of the two groups were lower than before surgery, and the modified group was lower than the percutaneous group (P < 0.05); the expressions of serum Cor, E and CK at 3 days after surgery in the two groups were higher than surgery before, but the levels of serum Cor, E and CK in the modified group were lower than those in the percutaneous group(P < 0.05); at 1 year after surgery, Cobb angles in two groups were smaller than before surgery, AVHR was larger than before surgery, and AVHR in the modified group was larger than that in the percutaneous group (P < 0.05); at 1 week and 1 month after surgery, VAS scores in two groups were lower than before surgery, and the modified group had lower VAS score than that in the percutaneous group (P < 0.05).
Conclusion Compared with percutaneous pedicle screw fixation, modified Wiltse approach is beneficial to shorten the operation time and intraoperative fluoroscopy time, and relieve stress response of the body for thoracolumbar type B fracture, which is of great significance to promote recovery of postoperative lumbar and back function as well as physiological anatomy, and relieve the pain of patients.

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