SSPI、万向型EPS及Can-Help微创椎弓根螺钉系统治疗无神经损伤胸腰椎骨折的疗效对比  

Comparison of percutaneous transluminal SSPI, universal EPS and Can-Help minimally invasive pedicle screw systems in treatment of patients with thoracolumbar fracture without nerve injury

作　　者：胡清勇[1] 张国峰[1] 杨辉[1] 郭家全[1] 常德勇[1] HU Qing-yong;ZHANG Guo-feng;YANG Hui;GUO Jia-quan;CHANG De-yong(Department of Orthopedics,Gerneral Hospital of Jizhong Energy Fengfeng Group,Handan 056200,Hebei Province,China)

机构地区：[1]冀中能源峰峰集团有限公司总医院骨科

出　　处：《医疗卫生装备》2019年第9期42-45,58,共5页Chinese Medical Equipment Journal

基　　金：邯郸市科学计划项目(2017JB220-R5)

摘　　要：目的:比较导引通道辅助下经皮置入短节段椎弓根钉棒(short-segment pedicle instrumentation,SSPI)、椎弓根螺钉(expensive pedicle screw,EPS)及Can-Help微创椎弓根螺钉系统治疗无神经损伤胸腰椎骨折患者的疗效差异。方法:选择2015年12月至2017年12月间收治的无神经损伤的胸腰椎骨折患者共150例,随机分为SSPI、EPS和Can-Help组,每组50例。SSPI组采用导引通道辅助下经皮置入SSPI治疗,EPS组采用万向型EPS治疗,Can-Help组采用Can-Help微创椎弓根螺钉系统治疗。比较3组患者的基本指标、术后Cobb角和视觉模拟评分(visual analog scale,VAS)变化情况,以及Oswestry功能障碍指数(Oswestry dability index,ODI)评分和生活质量评价量表SF-36评分。采用SPSS 19.0统计学软件进行数据处理。结果:EPS组的手术时间、术中出血量和住院时间显著低于SSPI组(P<0.05),Can-Help组的手术时间、术中出血量和住院时间均显著低于EPS组和SSPI组(P<0.05);术后3组患者的Cobb角均显著改善(P<0.05),但是随着时间推移Cobb角会随之升高(P<0.05),组间存在显著差异(P<0.05),其中术后Can-Help组具有最低的Cobb角,而EPS组具有最高的Cobb角;术后3组患者的VAS评分均显著降低(P<0.05),组间存在显著差异(P<0.05),其中术后Can-Help组具有最低的VAS评分而SSPI组具有最高的VAS评分(P<0.05);术后6个月和12个月 Can-Help组的ODI评分显著低于SSPI组和EPS组(P<0.05),而SF-36评分显著高于SSPI组和EPS组(P<0.05)。结论:经皮置入SSPI简便、椎体生理结构恢复优秀并可预防椎体高度的丢失;采用万向型EPS治疗相对于经皮置入SSPI手术难度更低,可减轻患者疼痛;采用Can-Help微创椎弓根螺钉系统治疗不但具有较好的效果,还可有效地减轻患者的疼痛。建议根据患者情况选择不同的手术方法。Objective To investigate the efficacies of percutaneous transluminal short-segment pedicle screw(SSPI), pedicle screw(EPS) and Can-Help minimally invasive pedicle screw systems in treating the patients with thoracolumbar fracture without nerve injury. Methods Totally 150 patients with thoracolumbar fracture without nerve injury from December 2015 to December 2017 were randomized into three groups. The patients in the SSPI group received percutaneous placement of SSPI with guided access, the patients in the EPS group were treated with EPS, and the patients in the Can-Help group underwent the treatment with Can-Help minimally invasive pedicle screw system. The basic indicators, postoperative Cobb angles and VAS scores of the three groups were compared, and the ODI and SF-36 scores of the three groups were evaluated. SPSS 19.0 software was used for data processing. Results The operation time, intraoperative blood loss and hospitalization time in the EPS group were significantly lower than those in the SSPI group(P<0.05), while those in the Can-Help group were statistically lower than those of the other two groups. Cobb angles were significantly improved in the three groups after surgery(P<0.05),which increased with time(P<0.05), and there were significant differences between the groups(P<0.05). The Can-Help group had the lowest Cobb angle after surgery, while the EPS group had the highest one. The VAS scores of the three groups were significantly lower after surgery(P<0.05), and there were significant differences between the groups(P<0.05), which had the lowest value in the Can-Help group and the highest value in the SSPI group(P <0.05). The Can-Help group had the ODI scores significantly lower than those of the SSPI group and the EPS group 6 months and 12 months after surgery(P<0.05), while the SF-36 scores significantly higher than those of the other two groups(P<0.05). Conclusion Percutaneous implantation of SSPI gains advantages in simplicity, recovery of vertebral body structure and prevention of loss of verteb

关 键 词：胸腰椎骨折 短节段椎弓根钉棒 万向型椎弓根螺钉 Can-Help微创椎弓根螺钉系统 Cobb角 微创手术 

分 类 号：R318[医药卫生—生物医学工程] R687.32[医药卫生—基础医学]