微创与传统开放附加伤椎经椎弓根螺钉内固定手术治疗胸腰椎骨折的疗效比较

The comparision of minimally invasive and traditional open treatment for thoracolumbar fractures with fixation using Sextant system

中文关键词:  脊柱骨折  经伤椎固定  经皮  椎弓根螺钉  内固定

英文关键词:Spinal fracture  Ｆixation of the fractured vertebra  Percutaneous  Pedicle screw  Ｆixation

中文摘要:

  【摘要】 目的：比较附加伤椎经椎弓根螺钉内固定的微创与传统开放手术治疗胸腰椎骨折的效果。方法：2006年12月～2009年3月选择42例胸腰椎骨折患者给予附加伤椎固定的三椎体六钉固定，分别采用Sextant系统下微创经皮椎弓根螺钉内固定手术（18例，微创组）和传统开放椎弓根螺钉内固定手术（24例，开放组），对两组患者围手术期相关指标、后凸畸形矫正情况、术后神经功能恢复、腰背痛改善等进行比较。结果：微创组与开放组相比，手术切口长度、手术时间、术中出血量、术后引流量、输血量、术后住院时间、术后使用止痛药的比例，以及术后手术伤口疼痛VAS评分、术后并发症等均有显著统计学差异（P<0.05）。两组术前与术后影像学比较，矢状位后凸Cobb角、伤椎自身成角、矢状位指数、伤椎椎体前缘高度均有显著性差异（P<0.01）。微创组术后Cobb′s角、伤椎自身成角、矢状面指数的改善程度与开放手术组比较差异无统计学意义（P>0.05），术后两组伤椎前缘高度差异有统计学意义（P<0.05），随访期间两组矫正度丢失差异无统计学意义（P>0.05）。结论：在严格掌握手术适应证的前提下，附加伤椎内固定的微创经皮椎弓根螺钉内固定术手术操作简单、安全可靠、创伤小、出血少、恢复快、住院时间短、术后并发症少，对伤椎畸形的矫正和内固定效果与传统开放手术相当。

英文摘要:

  【Abstract】　Objective：To assess the surgical therapeutic result of thoracolumbar fracture by percutaneous pedicle screw fixation with fixation through the pedicle of fractured vertebra or by traditional open fixation technique using Sextant system.Method：42 thoracolumbar fracture patients were divided into two groups：18 cases were included in the Sextant percutaneous pedicle screw fixation group（SPPSF） and 24 cases were in the open pedicle screw fixation group（OPSF）.The perioperative index including correction of kyphosis，recovery of neurological function and relief of the low back pain was compared.Result：There were significant differences in the incision size，surgical blood loss，surgical draining loss，surgical time，hospital stay，postoperative blood transfusion，the proportion of antalgic supplemented and VAS score between the two groups（P<0.01 or P<0.05）.The Cobb′s angle，sagittal index，local angle and anterior height of the fracture vertebral body were all significantly different between pre-operation and post-operation in each group（P<0.01）.There was no significant difference in postoperative improvement of Cobb′s angle，sagittal index，the local angle of fracture vertebral body and the loss of the correction in SPPSF group compared with OPSF group in the follow-up but there was significant difference in postoperative improvement of anterior height（P<0.05） of fractured vertebral body in the two groups.Conclusion：Percutaneous pedicle screw fixation using Sextant system is a good minimally-invasive surgical therapeutic choice for patients with thoracolumbar fracture，this method is simple，safe，with less complication and blood loss，and can provide quick recovery and short stay in hospital and comparable result of the traditional open operation.