经皮与开放椎弓根螺钉内固定术治疗无神经损伤胸腰椎A型骨折疗效对比  

Comparison of percutaneous and open pedicle screw internal fixation in the treatment of thoracolumbar type A fractures without nerve injury

作　　者：聂明军[1] 孙继芾[1] 张庆[1] 张广程[1] Nie Mingjun;Sun Jifei;Zhang Qing;Zhang Guangcheng(Department of Orthopaedics,Affiliated Hospital of Jiangsu University,Zhenjiang,Jiangsu 210031,China)

机构地区：[1]江苏大学附属医院骨科,江苏镇江210031

出　　处：《创伤外科杂志》2022年第11期825-830,共6页Journal of Traumatic Surgery

基　　金：江苏省自然科学基金青年科技人才专项(BK20162511)。

摘　　要：目的对比无神经损伤胸腰椎A型骨折采用开放或经皮椎弓根螺钉内固定术治疗的效果。方法回顾性分析2017年7月—2020年5月江苏大学附属医院骨科收治的无神经损伤胸腰椎A型骨折患者87例。根据手术方式不同分为开放组(开放椎弓根螺钉内固定术,42例)和经皮组(经皮椎弓根螺钉内固定术,45例)。开放组男性24例,女性18例;年龄23~46岁,平均32.6岁;道路交通伤21例,高处坠落伤16例,其他伤5例。经皮组男性26例,女性19例;年龄25~49岁,平均33.1岁;道路交通伤23例,高处坠落伤18例,其他伤4例。观察并比较两组围术期指标、视觉模拟评分、肌酸激酶、C反应蛋白、Cobb角、伤椎前缘高度、并发症发生率。结果经皮组手术出血量(97.6±11.0)mL、术后引流量(10.4±0.3)mL少于开放组的(289.4±17.8)mL、(185.1±15.2)mL,手术时间(53.6±6.3)min、住院天数(9.7±1.2)d、手术切口长度(60.7±6.2)mm少于开放组的(72.4±7.2)min、(14.2±2.3)d、(121.1±9.2)mm(P<0.05)。经皮组术后7、60、120d视觉模拟评分(3.9±0.4)分、(2.4±0.4)分、(1.3±0.2)分低于开放组(5.1±0.5)分、(3.9±0.6)分、(2.7±0.4)分(P<0.05)。经皮组术后24h血清肌酸激酶(167.9±15.1)U/L、C反应蛋白(11.5±2.4)mg/mL水平低于开放组的(248.2±16.2)U/L、(22.8±2.7)mg/mL(P<0.05)。两组术后7d、术后1年Cobb角、伤椎前缘高度比较差异无统计学意义(P>0.05)。经皮组的并发症发生率6.67%低于开放组的21.43%(P<0.05)。结论两种手术方式改善无神经损伤胸腰椎A型骨折患者Cobb角、伤椎前缘高度的效果相当,而经皮椎弓根螺钉内固定在缩短手术时间、手术切口长度、住院天数,减少术后引流量、手术出血量,减轻疼痛及应激刺激方面效果更好,同时经皮椎弓根螺钉内固定术并发症也相对更少,安全性更好。Objective To compare the efficacy of open or percutaneous pedicle screw fixation in the treatment of thoracolumbar type A fractures without nerve injury.Methods Eighty-seven patients with thoracolumbar type A fractures without nerve injury treated in the Department of Orthopaedics,Affiliated Hospital of Jiangsu University from Jul.2017 to May 2020 were retrospectively selected.The patients were divided into open group(open pedicle screw fixation,n=42)and percutaneous group(percutaneous pedicle screw fixation,n=45).In the open group,there were 24 males and 18 females;the age ranged from 23 to 46 years,mean 32.6 years;there were 21 cases of road traffic injuries,16 cases of falls from height,and 5 cases of others.In the percutaneous group,there were 26 males and 19 females,the age ranged from 25 to 49 years,mean 33.1 years;there were 23 cases of road traffic injuries,18 cases of falls from height,and 4 cases of others.The perioperative indexes,visual analogue scale(VAS)for pain evaluation,creatine kinase(CK),C-reactive protein(CRP),Cobb angle,height of the anterior edge of the injured vertebra,and the incidence of complications were observed and compared between the two groups.Results The intraoperative blood loss(97.6±11.0)mL and postoperative drainage(10.4±0.3)mL in percutaneous group were less than those in the open group(289.4±17.8)mL,(185.1±15.2)mL;and the operation time(53.6±6.3)min,hospital stay(9.7±1.2)d and length of the surgical incision(60.7±6.2)mm were shorter than those in open group[(72.4±7.2)min,(14.2±2.3)d,(121.1±9.2)mm](all P<0.05).At 7,60 and 120 d after operation,the VAS of percutaneous group was 3.9±0.4,2.4±0.4,and 1.3±0.2,respectively,much lower than that of open group(5.1±0.5,3.9±0.6,2.7±0.4)(all P<0.05).At 24 h after operation,the levels of serum CK(U/L)and CRP(mg/mL)were 167.9±15.1 and 11.5±2.4 for the percutaneous group,also significantly lower than those for the open group(248.2±16.2 and 22.8±2.7)(both P<0.05).The Cobb angle and height of the anterior edge revealed no s

关 键 词：胸腰椎骨折 神经损伤 螺钉 内固定 疗效 

分 类 号：R687.3[医药卫生—骨科学]