经皮与开放椎弓根螺钉内固定术对胸腰椎骨折椎体形态恢复的比较研究  

Comparison of the efficacy of percutaneous and open pedicle screw internal fixation for the restoration of vertebral morphology in thoracolumbar fractures

作　　者：郭浩华 余翔[2] 谢炜星[2] 张友 张学来 晋大祥[2] GUO Haohua;YU Xiang;XIE Weixing;ZHANG You;ZHANG Xuelai;JIN Daxiang(Guangzhou University of Chinese Medicine,Guangzhou 510405,China;Department of Orthopaedics,the First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,China)

机构地区：[1]广州中医药大学,广州510405 [2]广州中医药大学第一附属医院骨科,广州510405

出　　处：《中华骨与关节外科杂志》2024年第12期1082-1087,共6页Chinese Journal of Bone and Joint Surgery

摘　　要：目的:通过分析胸腰椎骨折患者术后伤椎形态的变化,探讨经皮和开放椎弓根螺钉内固定术治疗胸腰椎骨折的临床疗效。方法:回顾性分析2019年1月至2023年12月于广州中医药大学第一附属医院接受手术治疗的53例单节段胸腰椎骨折患者,根据手术方式将患者分为经皮椎弓根螺钉内固定术组(微创组)26例和开放椎弓根螺钉内固定术组(开放组)27例。收集两组患者的手术时间、术中出血量、住院时间,于术前、术后1周、术后3个月、末次随访评估Oswestry功能障碍指数(ODI)、疼痛视觉模拟评分(VAS),通过CT检查测量术前和拆钉时的伤椎正中矢状位面积、矢状位Cobb角、伤椎前缘高度。结果:所有患者均顺利完成置钉及拆钉手术,并获得5~18个月,平均(12.2±3.6)个月随访。两组患者拆钉时伤椎正中矢状位面积、矢状位Cobb角和伤椎前缘高度均较术前有所改善(P均<0.05),两组患者术前和拆钉时伤椎正中矢状位面积、矢状位Cobb角、伤椎前缘高度差异均无统计学意义(P均>0.05)。微创组患者术后1周和术后3个月ODI和VAS评分均优于开放组(P均<0.05)。两组患者手术时间差异无统计学意义(P>0.05),微创组患者术中出血量、住院天数均少于开放组(P均<0.05)。结论:经皮椎弓根螺钉内固定术在术中出血量、住院时间及术后早期ODI和VAS评分改善方面均优于开放椎弓根螺钉内固定术,而二者在恢复胸腰椎骨折椎体形态方面的疗效相当。Objective:To investigate the clinical efficacy of percutaneous pedicle screw internal fixation and open pedicle screw internal fixation in the treatment of thoracolumbar fractures by analyzing postoperative changes in injury vertebral morphology in patients with thoracolumbar fractures.Methods:A retrospective analysis was conducted on 53 patients with single-segment thoracolumbar fractures who underwent surgery at the First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2019 to December 2023.Patients were divided into two groups based on the surgical approach:the percutaneous pedicle screw internal fixation group(minimally invasive group,n=26)and the open pedicle screw internal fixation group(open group,n=27).Data on surgical time,intraoperative blood loss,and hospital stay of two groups were collected.The Oswestry Disability Index(ODI)and Visual Analog Scale(VAS)score for pain were assessed preoperatively,at 1 week and 3 months postoperatively,and at the final follow-up.Computed tomography(CT)was used to measure the mid-sagittal area,sagittal Cobb angle,and anterior height of the injured vertebra preoperatively and at the time of screw removal.Results:All patients successfully underwent screw insertion and removal surgeries and were followed up for 6 to 18 months,with a mean follow-up of 11.2±3.3 months.Both groups showed significant postoperative improvement in the mid-sagittal area of the injured vertebra compared to preoperative values(all P<0.05),with no statistically significant difference between the two groups either preoperatively or at the time of screw removal(all P>0.05).Both groups also showed significant improvements in the sagittal Cobb angle and the anterior vertebral height compared to preoperative values(all P<0.05),with no statistically significant differences between the two groups either preoperatively or at the time of screw removal(all P<0.05).The minimally invasive group had significantly better ODI and VAS score at 1 week and 3 months postoperatively compare

关 键 词：胸腰椎骨折 经皮椎弓根螺钉内固定术 开放椎弓根螺钉内固定术 

分 类 号：R683.2[医药卫生—骨科学]