微创减压联合经皮固定与传统开放手术治疗伴神经损害胸腰椎骨折的疗效比较

Comparative study of posterior mini-open decompression combined with percutaneous pedicle screw fixation vs traditional open reduction and internal fixation for thoracolumbar fracture complicated with neurological deficits

中文关键词:  胸腰椎骨折  微创小切口减压  经皮椎弓根螺钉固定  神经损伤

英文关键词:Thoracolumbar fracture  Mini-open decompression  Percutaneous pedicle screw fixation  Neurological deficits

中文摘要:

  【摘要】 目的：比较后路微创小切口减压联合经皮椎弓根螺钉复位内固定术与传统开放减压复位内固定术治疗伴神经功能损伤胸腰椎骨折的疗效。方法：我院自2011年12月~2014年6月收治56例伴神经功能损伤的胸腰椎骨折患者，分别采用后路小切口微创减压联合经皮椎弓根螺钉复位内固定术（26例，微创组）和传统开放后路减压椎弓根螺钉复位内固定术（30例，开放组），回顾性分析两组患者围手术期相关指标、影像学指标、术后神经功能恢复情况及并发症发生率并进行比较。结果：微创组手术切口肌肉剥离长度为7.46±2.67cm，术中出血量为271.54±125.53ml，术后引流量为74.50±73.58ml，输血比例为9/26，术后住院时间为19.19±10.66d，术后1周伤口疼痛视觉模拟评分（visual analogue scale VAS）为2.54±0.65分，术后止痛药使用比例为11/26；开放组分别为12.17±4.38cm，536.67±453.52ml，310.97±209.65ml，19/30，31.17±26.92d，3.60±0.77分和21/30，两组间比较有显著性差异（P＜0.05）；微创组手术时间（222.88±64.41min）与开放组（190.83±83.19min）无显著性差异（P＞0.05）。微创组手术前、后矢状面Cobb角为10.51°±16.12°、0.70°±12.97°，伤椎椎体前缘高度百分比为（52.27±8.34）%、（86.64±12.80）%，矢状面指数为14.63°±10.29°、7.43°±6.79°，伤椎楔变角为13.45°±7.40°、4.07°±4.81°；开放组分别为15.04°±9.84°、2.96°±9.84°，（48.58±11.48）%、（86.63±9.76）%，20.67°±17.58°、7.38°±5.63°，14.16°±6.77°、4.26°±4.39°，两组术后影像学指标均较术前明显改善（P＜0.05），两组影像学指标改善程度（术后-术前）相当（P＞0.05）。后期随访两组神经功能恢复情况和并发症发生率均无显著性差异（P＞0.05）。结论：后路微创小切口减压联合经皮椎弓根螺钉内固定术治疗伴神经功能损伤的胸腰椎骨折具有与传统开放手术同样的效果，且具有切口小、出血少、住院时间短、伤口疼痛轻等优点。

英文摘要:

  【Abstract】 Objectives: To compare the outcome of posterior mini-open decompression combined with percutaneous pedicle screw fixation with that of traditional open reduction and internal fixation for thoracolumbar fracture complicated with neurological deficits. Methods: 56 cases with neurological deficits of thoracolumbar fracture in our hospital from December 2011 to June 2014 were undertaken, 26 cases underwent posterior mini-open decompression combined with percutaneous pedicle screw fixation(MISS group), while 30 cases underwent traditional open posterior decompression and pedicle screw fixation(Open group), perioperative indexs, the imaging indexes, the neurological function recovery and complication incidence in two groups were compared. Results: The skin incision length, blood loss, postoperative drainage volume, transfusion proportion, postoperative hospital stay, visual analogue score(VAS score) and postoperative analgesics usage in MISS group was 7.46±2.67cm, 271.54±125.53ml, 74.50±73.58ml, 9/17, 19.19±10.66d, 2.54±0.65 and 11/15, respectively, while 12.17±4.38cm, 536.67±453.52ml, 310.97±209.65ml, 19/11, 31.17±26.92d, 3.60±0.77 and 21/9, respectively in the Open group, which showed significant differences(P＜0.05) between 2 groups, but the operation time between two groups(222.88±64.41 and 190.83±83.19min) showed no difference(P>0.05). In MISS group, preoperative and postoperative sagittal Cobb angle, vertebral height percentage, sagittal index and vertebral wedging angle was (10.51±16.12°, 0.70±12.97°), (52.27±8.34%, 86.64±12.80), (14.63±10.29°, 7.43±6.79°) and (13.45±7.40°, 4.07±4.81°) respectively, while (15.04±9.84, 2.96±9.84), (48.58±11.48, 86.63±9.76), (20.67±17.58, 7.38±5.63) and (14.16±6.77, 4.26±4.39) respectively for Open group. In both group, the postoperative imaging indexes significantly improved compared with the preoperative ones(P＜0.05), but the improved rate(postoperative - preoperative) showed no statistical difference(P>0.05). At later follow-up, nerve function recovery, as well as complication rates showed no statistical significance between 2 groups(P>0.05). Conclusions: Posterior mini-open decompression combined with percutaneous pedicle screw fixation in the treatment of thoracolumbar fracture with neurological deficits has the same effects as traditional open surgery, and has a small incision, less blood loss, shorter hospital stay, less wound pain and other advantages.