经皮与开放椎弓根钉内固定术后创伤反应相关血清指标的比较研究  

Comparison of traumatic related index in serum between minimally invasive and open pedicle screw fixation

作　　者：邹澍[1] 吕仁发[1] 刘加钱[1] 舒荣兵[1] 潘小峰[1] 吴刚[1] ZOU Shu;LV Ren-fa;LIU Jia-qian;SHU Rong-bing;PAN Xiao-feng;WU Gang(First Department of Orthopedics,the 184th Hospital of PLA,Yingtan,Jiangxi　335000,China)

机构地区：[1]解放军第184医院骨科一病区,江西鹰潭335000

出　　处：《创伤外科杂志》2018年第3期221-224,共4页Journal of Traumatic Surgery

摘　　要：目的观察传统切开复位内固定术与微创经皮内固定术治疗胸腰椎骨折术后创伤相关的血清指标变化并探讨其意义。方法选择2014年5月—2016年10月符合标准的48例单节段胸腰椎骨折患者,行体外复位、经皮椎弓根螺钉内固定手术(微创组)23例,传统切开复位椎弓根螺钉内固定手术(开放组)25例。记录并比较两组患者手术时间、术中出血量、内固定前后矢状位Cobb角和椎体前缘高度百分比、术后切口疼痛VAS评分、术后住院时间等指标;分别检测两组患者术前及术后24h C反应蛋白(C-reactive protein,CRP)及肌酸激酶(creatine kinase,CK)浓度以及术前和术后2、8、24、48h患者血清中白介素-6(interleukin-6,IL-6)、白介素-10(interleukin-10,IL-10)的水平。结果微创组患者的平均手术时间、术中出血、住院时间分别为(64.5±13.9)min、(57.3±21.1)m L、(7.2±2.7)d,均明显少于开放组的(81.2±17.3)min、(223.4±76.4)m L、(9.0±4.2)d,术后1~3d切口VAS评分低于开放组(P<0.05)。比较两组患者术后矢状位Cobb角及椎体前缘高度百分比无明显差异。微创组术后24h血清CRP和CK浓度明显低于开放组(P<0.01)。术后各时间点微创组IL-6和IL-10浓度均低于开放组(P<0.05)。结论微创经皮椎弓根螺钉治疗胸腰椎骨折较传统的开放手术具有更轻微的组织损伤及系统炎症反应。Objective To observe the change of traumatic related index in serum between minimally invasive percutaneous pedicle screw fixation and traditional open pedicle screw fixation and investigate its significance.Methods Forty-eight single segment thoracolumbar fracture patients between May 2014 and Oct.2016 were enrolled in this study.Twenty-three cases were divided into the percutaneous pedicle screw fixation group(minimally invasive group)and 25 cases were divided into the open pedicle screw fixation group(open group).The operative time,intra-operative blood loss,pre-and post-operative Cobb angle,anterior vertebral body height ratio,VAS scores of incision pain and postoperative hospital stay were recorded and compared between the two groups.The serum levels of CRP and CK were measured before operation and 24h after operation.The serum levels of IL-6 and IL-10 were measured at preoperation and 2,8,24,48h postoperatively.Results The operative time,intra-operative blood loss,postoperative hospital stay and VAS scores of incision pain were significantly less in the minimally invasive group than those in the open group(P<0.05).The post-operative Cobb angle and anterior vertebralbody height ratio had no significant difference between the two groups(P>0.05).The levels of CK and CRP at 24h after operation in the minimally invasive group were significantly lower than those in the open group(P<0.05).The levels of IL-6 and IL-10 in minimally invasive group were lower than those in the open group at every time point after surgery(P<0.05).Conclusion Minimally invasive percutaneous pedicle screw fixation may significantly reduce tissue injury and systemic inflammatory reactions than the traditional open pedicle screw fixation.

关 键 词：胸腰椎骨折 椎弓根螺钉 内固定 微创手术 组织损伤 炎症因子 

分 类 号：R687.3[医药卫生—骨科学]